Healthcare Provider Details

I. General information

NPI: 1952821662
Provider Name (Legal Business Name): CULLEN SALADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11775 TECUMSEH-CLINTON HWY
CLINTON MI
49236-9541
US

IV. Provider business mailing address

11775 TECUMSEH-CLINTON HWY
CLINTON MI
49236-9541
US

V. Phone/Fax

Practice location:
  • Phone: 517-456-7449
  • Fax: 517-456-6059
Mailing address:
  • Phone: 517-456-7449
  • Fax: 517-456-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301506288
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: