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General NPI Number Information
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NPI Number | 1538446828
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Entity Type | Organization
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Legal Business Name | CULLAIN LLC
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 6333 ODANA RD STE 20
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City | MADISON
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State | WI
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Zip | 53719-1170
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Country | US
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Telephone | 608-270-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 W SKYLINE DR
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City | MADISON
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State | WI
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Zip | 53705-1135
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Country | US
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Telephone | 608-212-4822
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHIATRIST
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Name | RANDALL CULLEN
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Credential | M.D.
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Telephone | 608-238-6998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 21235-20
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License Number State | WI
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