# MICHAEL R. MCCULLOUGH, D.O., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275832362
- **Authorized official:** DR. MICHAEL R. MCCULLOUGH D.O. (PHYSICIAN)
- **Authorized official phone:** (972) 988-1588

## Contact information

- **Practice address:** 643 S GREAT SOUTHWEST PKWY, SUITE 101, GRAND PRAIRIE, TX 75051-1056
- **Practice address phone:** (972) 602-0615
- **Mailing address:** 643 S GREAT SOUTHWEST PKWY, SUITE 101, GRAND PRAIRIE, TX 75051-1056
- **Mailing address phone:** (972) 602-0615

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | H9682 | TX | Yes |

## Other

- **Enumeration date:** 03/15/2011
- **Last updated:** 03/15/2011