Healthcare Provider Details

I. General information

NPI: 1992791925
Provider Name (Legal Business Name): STEVEN K MCCULLOUGH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 HILTY DRIVE
PANDORA OH
45877-9703
US

IV. Provider business mailing address

202 HILTY DRIVE PO BOX 299
PANDORA OH
45877-0299
US

V. Phone/Fax

Practice location:
  • Phone: 419-384-3251
  • Fax: 419-384-3269
Mailing address:
  • Phone: 419-384-3251
  • Fax: 419-384-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-00-3153-M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: