Healthcare Provider Details

I. General information

NPI: 1518559236
Provider Name (Legal Business Name): DEEPTHI S CULL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EDDIE DOWLING HWY
NORTH SMITHFIELD RI
02896-7327
US

IV. Provider business mailing address

4225 LINCOLNSHIRE DR STE B
MOUNT VERNON IL
62864-2157
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-2200
  • Fax:
Mailing address:
  • Phone: 618-242-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DEEPTHI S CULL
Title or Position: PRESIDENT
Credential: MD
Phone: 847-767-0137