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General NPI Number Information
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NPI Number | 1902011703
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Entity Type | Individual
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Provider Name | MARYK CULLEN MARYK CULLEN, M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2431 N GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63106-1018
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Country | US
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Telephone | 314-652-9233
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Fax | 314-533-5430
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Provider Business Mailing Address
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Address Line | 6315 PERSHING AVE
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City | UNIVERSITY CITY
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State | MO
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Zip | 63130-4704
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Country | US
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Telephone | 314-721-8267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 106422
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License Number State | MO
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