Healthcare Provider Details

I. General information

NPI: 1285664680
Provider Name (Legal Business Name): PAUL A CULLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25100 KELLY RD
ROSEVILLE MI
48066
US

IV. Provider business mailing address

25100 KELLY RD
ROSEVILLE MI
48066-4910
US

V. Phone/Fax

Practice location:
  • Phone: 586-771-7440
  • Fax: 586-771-9966
Mailing address:
  • Phone: 586-771-7440
  • Fax: 586-771-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number036162698
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME61860
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberPC044124
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036162698
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: