Individual
BRIAN PETER MCCULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1875 DEMPSTER ST, SUITE 325, PARK RIDGE, IL 60068-1186
(847) 723-8610
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
036076949
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036076949
ILLINOIS STATE LICENSE NU
IL
01
—
36-4024817
TAX ID
IL
Enumeration date
06/23/2006
Last updated
06/20/2023
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