Provider Demographics
NPI:1275988578
Name:CULLUM, CHRISTOPHER L (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:CULLUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11821 MASON MONTGOMERY RD STE 4B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-3705
Mailing Address - Country:US
Mailing Address - Phone:513-489-2400
Mailing Address - Fax:513-489-2455
Practice Address - Street 1:11821 MASON MONTGOMERY RD # 4B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-3705
Practice Address - Country:US
Practice Address - Phone:513-489-2400
Practice Address - Fax:513-489-2455
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH59.000623213ES0103X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH27-1408630OtherJEWISH HOSPITAL