Provider Demographics
NPI:1851329114
Name:CULLEN, MICHAEL P (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:CULLEN
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 1:16909 BURKE ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118
Mailing Address - Country:US
Mailing Address - Phone:402-333-8856
Mailing Address - Fax:402-333-3428
Practice Address - Street 1:16909 BURKE ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118
Practice Address - Country:US
Practice Address - Phone:402-333-8856
Practice Address - Fax:402-333-3428
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE220213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47074840507Medicaid
NEP00059988OtherMEDICARE RR
U05918Medicare UPIN
NE47074840507Medicaid