Healthcare Provider Details

I. General information

NPI: 1700045564
Provider Name (Legal Business Name): JOHN PATRICK CULLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 E GALBRAITH RD SUITE 108
CINCINNATI OH
45236-6703
US

IV. Provider business mailing address

4760 E GALBRAITH RD SUITE 108
CINCINNATI OH
45236-6703
US

V. Phone/Fax

Practice location:
  • Phone: 513-686-5392
  • Fax: 513-686-5394
Mailing address:
  • Phone: 513-686-5392
  • Fax: 513-686-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA100105
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35.099812
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: