Provider Demographics
NPI:1013093178
Name:WHITE, CULLY R (DO)
Entity type:Individual
Prefix:MR
First Name:CULLY
Middle Name:R
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2901 W KINNICKINNIC RIVER PARKWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-649-3232
Mailing Address - Fax:414-385-1929
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PARKWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-649-3232
Practice Address - Fax:414-385-1929
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI42084207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70026400Medicare ID - Type Unspecified
G39092Medicare UPIN