Provider Demographics
NPI:1932381449
Name:DR. CULLY R. WHITE, NEUROSURGERY & SPINE SC
Entity Type:Organization
Organization Name:DR. CULLY R. WHITE, NEUROSURGERY & SPINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CULLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:414-649-3232
Mailing Address - Street 1:8507 SOLUTION CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-8005
Mailing Address - Country:US
Mailing Address - Phone:414-649-3904
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1013093178OtherNPI
WI000001935Medicare PIN
WI5490120001Medicare NSC
WI000001935Medicare Oscar/Certification