Provider Demographics
NPI:1619923927
Name:CULLEN, KATHLEEN A (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:CULLEN
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 1:10575 68TH AVE N
Mailing Address - Street 2:SUITE A1
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-6035
Mailing Address - Country:US
Mailing Address - Phone:727-392-8600
Mailing Address - Fax:727-392-8686
Practice Address - Street 1:10575 68TH AVE N
Practice Address - Street 2:SUITE A1
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-6035
Practice Address - Country:US
Practice Address - Phone:727-392-8600
Practice Address - Fax:727-392-8686
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70549207R00000X
KS04-37962207R00000X
ALMD.32673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG26783Medicare UPIN
FL31816ZMedicare PIN