Provider Demographics
NPI:1437954484
Name:GULCHUK, SAMUEL MAX
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MAX
Last Name:GULCHUK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22502 A ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:NE
Mailing Address - Zip Code:68347-1946
Mailing Address - Country:US
Mailing Address - Phone:402-540-9368
Mailing Address - Fax:
Practice Address - Street 1:5012 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68524-1035
Practice Address - Country:US
Practice Address - Phone:402-540-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant