Provider Demographics
NPI:1477519239
Name:CULLADO, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:CULLADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:PO BOX 2090
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-996-0347
Mailing Address - Fax:330-996-8695
Practice Address - Street 1:550 E MARKET ST
Practice Address - Street 2:SUITE 103
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1613
Practice Address - Country:US
Practice Address - Phone:330-434-5978
Practice Address - Fax:330-434-6908
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-055832208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0855623Medicaid
OH0855623Medicaid
E76750Medicare UPIN