MEDICARE: CASS M CULLIS MD

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	35.041154	OH

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	:	1982607172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASS M CULLIS MD

Provider Business Mailing Address
First Line	:	3006 N COUNTY ROAD 25A
Second Line	:	STE 104
City	:	TROY
State	:	OH
Zip	:	45373-1373
Country	:	US
Telephone Number	:	937-335-3518
Fax Number	:	937-332-6857

Provider Business Practice Location Address
First Line	:	3006 N COUNTY ROAD 25A
Second Line	:	STE 104
City	:	TROY
State	:	OH
Zip	:	45373-1373
Country	:	US
Telephone Number	:	937-335-3518
Fax Number	:	937-332-6857

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/02/2013

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Directions to “ CASS M CULLIS MD” Practice Location

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