Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | 4301065533 | MI |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 4301065533 | MI |
NPI | 1518916535 |
---|---|
Provider Name | William T Cullen |
First Address | Grand Rapids, MI 49503-4607 |
Second Address | Grand Rapids, MI 49503-4607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4273703 | (05) | MI |
H41005 | (02) | MI |