Individual
MARC L. CULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
CHILDRENS HOSPITAL OF MICHIGAN, 3901 BEAUBIEN BLVD, DETROIT, MI 48201
(313) 831-3220
(313) 831-3908
Mailing address
CHILDRENS HOSPITAL OF MICHIGAN, 3901 BEAUBIEN BLVD, DETROIT, MI 48201
(313) 831-3220
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
4301047728
MI
2086S0120X
Pediatric Surgery Physician
Primary
4301047728
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000521507
ANTHEM
OH
01
—
04672
PARAMOUNT
OH
01
—
147948
GLHP
—
05
—
1816457
—
MI
01
—
2515273
BCMH
OH
05
—
2515273
—
OH
05
—
4115615
—
MI
01
—
4507190
AETNA
OH
05
—
5202214
—
MI
01
—
8161
HEALTH PLAN OF MI
—
01
—
MC047728
CHAMPUS-CHAMPUS
—
Enumeration date
07/26/2005
Last updated
03/21/2008
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