MEDICARE: LOUISE D MCCULLOUGH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	Q6233	TX
2	2084V0102X	Vascular Neurology Physician	Q6233	TX

General Provider Information

NPI Number	:	1447256441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE D MCCULLOUGH MD

Provider Business Mailing Address
First Line	:	6431 FANNIN ST
Second Line	:	MSB 7.044
City	:	HOUSTON
State	:	TX
Zip	:	77030-3969
Country	:	US
Telephone Number	:	713-500-7079
Fax Number	:	713-500-0660

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST
Second Line	:	SUITE 1014
City	:	HOUSTON
State	:	TX
Zip	:	77030-3000
Country	:	US
Telephone Number	:	832-325-7080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	10/23/2018

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