Provider Demographics
NPI:1194899948
Name:CULLER, FREDRICK I (MD)
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:I
Last Name:CULLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FREDRICK
Other - Middle Name:I
Other - Last Name:CULLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 714813
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4813
Mailing Address - Country:US
Mailing Address - Phone:937-293-0247
Mailing Address - Fax:937-293-0960
Practice Address - Street 1:801 MEDICAL DR STE B
Practice Address - Street 2:INSTITUTE FOR ORTHOPAEDIC SURGERY
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804
Practice Address - Country:US
Practice Address - Phone:419-224-7586
Practice Address - Fax:419-224-9769
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35024259207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0002446Medicaid
C00526Medicare UPIN
OHCM0122133Medicare ID - Type Unspecified