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Individual
MR. MICHAEL DEAN CULLER
Active
Individual
MR. MICHAEL DEAN CULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110004396
VA
363A00000X
Physician Assistant
Primary
101079
NC
363AM0700X
Medical Physician Assistant
101079
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053424598
—
NC
05
—
1053424598
—
VA
01
—
153YK
BCBS NC
NC
01
—
261083931
TAX ID
—
01
—
2760137
MEDICARE
NC
01
—
DN2980
GROUP PTAN
VA
01
—
P01130746
PTAN
VA
Enumeration date
08/17/2006
Last updated
08/24/2022
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