Individual
RANDALL KEITH CULLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6333 ODANA RD STE 20, MADISON, WI 53719-1170
(608) 212-4822
Mailing address
1414 W SKYLINE DR, MADISON, WI 53705-1135
(608) 212-4822
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
21235
WI
2084P0804X
Child & Adolescent Psychiatry Physician
21235
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21235
MEDICAL LICENSE
WI
05
—
31687500
—
WI
Enumeration date
06/26/2006
Last updated
01/03/2012
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