Individual
KYLE ALAN MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-1921
(860) 679-1411
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-1921
(860) 679-1411
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
U5754
TX
2086S0102X
Surgical Critical Care Physician
U5754
TX
390200000X
Student in an Organized Health Care Education/Training Program
Primary
81585
CT
Other
Enumeration date
04/04/2017
Last updated
11/02/2025
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