MEDICARE: DR. MORRIS WADE PULLIAM 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	207T00000X	Neurological Surgery Physician	35075439P	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	PU0872354	OTHER	OH	MEDICARE ID

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	:	1811976087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORRIS WADE PULLIAM M.D.

Provider Business Mailing Address
First Line	:	358 BIRCH ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44301-2602
Country	:	US
Telephone Number	:	330-773-3544
Fax Number	:	330-773-3698

Provider Business Practice Location Address
First Line	:	2658 ELM RD NE
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-9393
Country	:	US
Telephone Number	:	330-773-3544
Fax Number	:	330-773-3698

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	02/07/2008

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