Healthcare Provider Details

I. General information

NPI: 1982607172
Provider Name (Legal Business Name): CASS M CULLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 N COUNTY ROAD 25A STE 104
TROY OH
45373-1373
US

IV. Provider business mailing address

3006 N COUNTY ROAD 25A STE 104
TROY OH
45373-1373
US

V. Phone/Fax

Practice location:
  • Phone: 937-335-3518
  • Fax: 937-332-6857
Mailing address:
  • Phone: 937-335-3518
  • Fax: 937-332-6857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.041154
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: