Healthcare Provider Details

I. General information

NPI: 1215131701
Provider Name (Legal Business Name): KIRK A MCCULLOUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 COLLEGE BLVD STE 100A
LEAWOOD KS
66211-1910
US

IV. Provider business mailing address

3651 COLLEGE BLVD STE 100A
LEAWOOD KS
66211-1910
US

V. Phone/Fax

Practice location:
  • Phone: 913-319-7600
  • Fax: 913-253-1702
Mailing address:
  • Phone: 913-319-7600
  • Fax: 913-253-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number2013026069
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number35.121283
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number04-36662
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2013026069
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35.121283
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number04-36662
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: