Provider Demographics
NPI:1770589236
Name:CULLINANE, DAVID W (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:CULLINANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:6400 INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2452
Mailing Address - Country:US
Mailing Address - Phone:414-423-4100
Mailing Address - Fax:
Practice Address - Street 1:2808 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2127
Practice Address - Country:US
Practice Address - Phone:262-354-8415
Practice Address - Fax:414-646-3002
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36506207RC0000X, 207RI0011X
NE23105207RC0000X
WI51047207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34964600Medicaid
WI004868765Medicare PIN
G60582Medicare UPIN