MEDICARE: WHELAN W. CULLEY III MD PA

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	ME0042533	FL

General Provider Information

NPI Number	:	1871533158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHELAN W. CULLEY III MD PA

Provider Business Mailing Address
First Line	:	8211- 113 STREET NORTH
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-4128
Country	:	US
Telephone Number	:	727-398-5295
Fax Number	:	727-391-2742

Provider Business Practice Location Address
First Line	:	8211- 113 ST. NORTH
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-4128
Country	:	US
Telephone Number	:	727-398-5295
Fax Number	:	727-391-2742

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARY W CULLEY III
Credential	:	M.D.
Telephone Number	:	727-398-5295

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/22/2020

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