MEDICARE: STEPHEN L CULLEN D.O.

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
1	207Q00000X	Family Medicine Physician	02000680	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000915642	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760456305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN L CULLEN D.O.

Provider Business Mailing Address
First Line	:	2005 STATE ST
Second Line	:	SUITE A
City	:	WASHINGTON
State	:	IN
Zip	:	47501-8505
Country	:	US
Telephone Number	:	812-254-4650
Fax Number	:	812-254-4081

Provider Business Practice Location Address
First Line	:	2005 STATE ST
Second Line	:	SUITE A
City	:	WASHINGTON
State	:	IN
Zip	:	47501-8505
Country	:	US
Telephone Number	:	812-254-4650
Fax Number	:	812-254-4081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	09/16/2016

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