MEDICARE: DR. CHARLES CODY CULL DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	1201	NV
2	213E00000X	Podiatrist	07000745A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	07000745C	OTHER	IN	CONTROLLED SUBSTANCE #

General Provider Information

NPI Number	:	1275619603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES CODY CULL DPM

Provider Business Mailing Address
First Line	:	1717 NAVAJO LAKE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3283
Country	:	US
Telephone Number	:	702-596-5589
Fax Number	:	725-205-4844

Provider Business Practice Location Address
First Line	:	1717 NAVAJO LAKE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3283
Country	:	US
Telephone Number	:	702-596-5589
Fax Number	:	725-205-4844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	10/28/2019

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