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NPI Code Detail

MEDICARE: SUSAN D MCCULLUM M.D.

MEDICARE: SUSAN D MCCULLUM M.D.
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
1208000000XPediatrics PhysicianME86366FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27768378OTHERFLAETNA
31483313OTHERFLUNITED
462808OTHERFLBLUE CROSS

General Provider Information

NPI Number : 1578554291
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN D MCCULLUM M.D.
Provider Business Mailing Address
First Line : PO BOX 1357
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-1357
Country : US
Telephone Number : 239-278-3600
Fax Number : 239-278-3857
Provider Business Practice Location Address
First Line : 2232 GRAND AVE
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-3717
Country : US
Telephone Number : 239-344-2341
Fax Number : 239-334-7518
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 04/30/2010

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Directions to “ SUSAN D MCCULLUM M.D.” Practice Location

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