Individual
WAYNE M MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
21813 CAPPEL LN, FRANKFORT, IL 60423-2275
(978) 549-6818
(847) 674-0892
Mailing address
21813 CAPPEL LN, FRANKFORT, IL 60423-2275
(978) 549-6818
(847) 674-0892
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1939
MA
213EP1101X
Primary Podiatric Medicine Podiatrist
1939
MA
213ES0000X
Sports Medicine Podiatrist
1939
MA
213ES0131X
Foot Surgery Podiatrist
1939
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0363037
—
MA
Enumeration date
11/22/2006
Last updated
09/21/2015
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