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General NPI Number Information
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NPI Number | 1073713376
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Entity Type | Organization
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Legal Business Name | MICHAEL L. MCCULLOUGH MD PA
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 8411 PRESTON RD #200
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City | DALLAS
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State | TX
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Zip | 75225-5523
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Country | US
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Telephone | 214-265-8646
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Fax | 214-361-1939
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Provider Business Mailing Address
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Address Line | 8411 PRESTON RD #200
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City | DALLAS
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State | TX
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Zip | 75225-5523
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Country | US
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Telephone | 214-265-8646
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Fax | 214-361-1939
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL L MCCULLOUGH
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Credential | M.D.
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Telephone | 214-265-8646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0965
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License Number State | TX
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