Provider Demographics
NPI:1265660062
Name:CIULLO, JEREMY RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:RYAN
Last Name:CIULLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11012 E 13 MILE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2546
Mailing Address - Country:US
Mailing Address - Phone:586-751-3380
Mailing Address - Fax:586-751-0950
Practice Address - Street 1:11012 E 13 MILE RD STE 112
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-573-5880
Practice Address - Fax:586-573-2562
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2023-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010948312086S0105X
MI43010949212086S0102X
KY497112086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care