Individual
ANDREA S KULDANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8005
(616) 840-9642
Mailing address
3350 EAGLE PARK DR NE, SUITE 108, GRAND RAPIDS, MI 49525-4570
(616) 458-1088
(616) 458-7809
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
4301041190
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1403831
—
MI
01
—
RR250010074
MEDICARE RR
MI
Enumeration date
07/30/2006
Last updated
03/30/2021
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