Provider Demographics
NPI:1497749113
Name:CULL, DEEPTHI S (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPTHI
Middle Name:S
Last Name:CULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEEPTHI
Other - Middle Name:S
Other - Last Name:SAXENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4225 LINCOLNSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2157
Mailing Address - Country:US
Mailing Address - Phone:618-242-2317
Mailing Address - Fax:
Practice Address - Street 1:5001 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0648
Practice Address - Country:US
Practice Address - Phone:613-323-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111103208100000X
IN01074358A208100000X
RIMD18671208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300001148Medicaid
IN300001148Medicaid
ILK19866/209384Medicare ID - Type Unspecified