MEDICARE: DR. DAVID W CULLINANE 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	207RC0000X	Cardiovascular Disease Physician	36506	CO
2	207RC0000X	Cardiovascular Disease Physician	23105	NE
3	207RI0011X	Interventional Cardiology Physician	36506	CO
4	207RC0000X	Cardiovascular Disease Physician	51047	WI

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

General Provider Information

NPI Number	:	1770589236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID W CULLINANE M.D.

Provider Business Mailing Address
First Line	:	6400 INDUSTRIAL LOOP
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-2452
Country	:	US
Telephone Number	:	414-423-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2808 HERITAGE DR
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-2127
Country	:	US
Telephone Number	:	262-354-8415
Fax Number	:	414-646-3002

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	03/12/2025

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