Healthcare Provider Details

I. General information

NPI: 1275605768
Provider Name (Legal Business Name): JOHN JEFFREY MCCULLOUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE STREET SE, ROOM 760 UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

UNIVERSITY OF MINNESOTA PHYSICIANS 420 DELAWARE STREET SE, MMC 609
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-0622
  • Fax: 612-626-2696
Mailing address:
  • Phone: 612-626-0622
  • Fax: 612-626-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number19412
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number19412
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: