Individual
DR. KIM LESLIE MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 OSBORN BLVD, SUITE 2600, SAULT SAINTE MARIE, MI 49783-1899
(906) 635-1048
(906) 635-3103
Mailing address
550 OSBORN BLVD, SUITE 2600, SAULT SAINTE MARIE, MI 49783-1899
(906) 635-1048
(906) 635-3103
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
KM405465
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2698385
—
MI
01
—
382967127
TAX IDENTIFICATION
MI
Enumeration date
05/16/2006
Last updated
02/22/2010
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