Provider Demographics
NPI:1376573691
Name:CUCULIC, LINDA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOUISE
Last Name:CUCULIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9393
Mailing Address - Country:US
Mailing Address - Phone:330-372-8800
Mailing Address - Fax:330-372-8999
Practice Address - Street 1:2600 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9393
Practice Address - Country:US
Practice Address - Phone:330-372-8800
Practice Address - Fax:330-372-8999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341341025035OtherCARESOURCE
OH000000243191OtherANTHEM BC/BS OHIO
OH0703895Medicaid
OH78932OtherHEALTH ASSURANCE
OHQ006179OtherHOMETOWN
OH102140OtherUNITED HEALTHCARE
OHJ56519OtherSUMMACARE
OH$$$$$$$$$007OtherMEDICAL MUTUAL OF OHIO
OH102140OtherUNITED HEALTHCARE
OH$$$$$$$$$OtherTRICARE/HEALTHNET
OH000000243191OtherANTHEM BC/BS OHIO
OH341341025035OtherCARESOURCE