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NPI Code Detail

MEDICARE: CULLEN LEEANN KISNER MD

MEDICARE: CULLEN LEEANN KISNER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery PhysicianMT237609PA

General Provider Information

NPI Number : 1134086531
Entity Type Code : Individual
Provider Name (Legal Business Name) : CULLEN LEEANN KISNER MD
Provider Business Mailing Address
First Line : 100 E LANCASTER AVE
Second Line :
City : WYNNEWOOD
State : PA
Zip : 19096-3450
Country : US
Telephone Number : 484-476-2000
Fax Number :
Provider Business Practice Location Address
First Line : 100 E LANCASTER AVE
Second Line :
City : WYNNEWOOD
State : PA
Zip : 19096-3450
Country : US
Telephone Number : 484-476-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2026
Last Update Date : 06/02/2026

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