Individual
KEVIN MCCULLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
96 COURT ST, PLATTSBURGH, NY 12901-2733
(518) 562-1080
(518) 562-3316
Mailing address
154 PROSPECT AVE, PLATTSBURGH, NY 12901-1302
(518) 563-5440
(518) 563-1206
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
164868
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01279267
—
NY
Enumeration date
09/16/2006
Last updated
02/18/2020
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