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General NPI Number Information
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NPI Number | 1942216478
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Entity Type | Individual
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Provider Name | DEBORAH L MCCULLOUGH M.D
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Gender | Female
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 6091 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2619
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Country | US
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Telephone | 219-763-8113
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1430
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City | PORTAGE
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State | IN
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Zip | 46368-9230
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Country | US
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Telephone | 219-763-8112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01026315A
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License Number State | IN
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