Individual
DR. PHYLLIS ANNE CULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1437 KILAUEA AVE, SUITE 103, HILO, HI 96720-4200
(808) 498-4160
(808) 498-4163
Mailing address
PO BOX 1477, HILO, HI 96721-1477
(530) 895-3287
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
G32403
CA
208VP0014X
Interventional Pain Medicine Physician
Primary
MD 17298
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G324030
—
CA
01
—
00G324032
MEDICARE INDIVIDUAL PTAN
CA
01
—
1881883320
MEDICARE GROUP NPI
CA
01
—
ZZZ06195Z
MEDICARE GROUP PTAN
CA
Enumeration date
05/02/2006
Last updated
01/20/2015
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