Individual
STEPHANIE L KULAVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
800 N 1ST ST, SPRINGFIELD, IL 62702-3778
(217) 528-7541
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
085010016
IL
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
02/18/2019
Last updated
09/10/2024
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