Individual
JACQUELYN MICHELLE KUKULSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
02007548A
IN
208000000X
Pediatrics Physician
036.157681
IL
208000000X
Pediatrics Physician
125.074969
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103769274
ANTHEM
IN
05
—
300083601
—
IN
05
—
390200000X
—
IL
Enumeration date
04/01/2019
Last updated
04/22/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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