Provider Demographics
NPI:1811943772
Name:CULLEN, JASON W (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:CULLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:471 W ARMY TRAIL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2673
Mailing Address - Country:US
Mailing Address - Phone:630-980-3366
Mailing Address - Fax:630-980-3686
Practice Address - Street 1:471 W ARMY TRAIL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2673
Practice Address - Country:US
Practice Address - Phone:630-980-3366
Practice Address - Fax:630-980-3686
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-08310207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL724470Medicare ID - Type UnspecifiedDUPAGE COUNTY
ILI10581Medicare UPIN
IL200575Medicare ID - Type UnspecifiedCOOK COUNTY