MEDICARE: LINDA LOUISE CUCULIC M.D.

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	207Q00000X	Family Medicine Physician	35056519	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	341341025035	OTHER	OH	CARESOURCE
2	000000243191	OTHER	OH	ANTHEM BC/BS OHIO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	78932	OTHER	OH	HEALTH ASSURANCE
5	Q006179	OTHER	OH	HOMETOWN
6	102140	OTHER	OH	UNITED HEALTHCARE
7	J56519	OTHER	OH	SUMMACARE

General Provider Information

NPI Number	:	1376573691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA LOUISE CUCULIC M.D.

Provider Business Mailing Address
First Line	:	2600 STATE ROUTE 5
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-9393
Country	:	US
Telephone Number	:	330-372-8800
Fax Number	:	330-372-8999

Provider Business Practice Location Address
First Line	:	2600 STATE ROUTE 5
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-9393
Country	:	US
Telephone Number	:	330-372-8800
Fax Number	:	330-372-8999

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	04/20/2008

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Directions to “ LINDA LOUISE CUCULIC M.D.” Practice Location

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