Organization
PRAIRIE PODIATRY INC.
Active
Organization
PRAIRIE PODIATRY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE MCCULLOUGH DPM (PRESIDENT)
(978) 549-6818
Entity
Organization
Contact information
Practice address
21813 CAPPEL LN, FRANKFORT, IL 60423-2275
(978) 549-6818
Mailing address
21813 CAPPEL LN, FRANKFORT, IL 60423-2275
(978) 549-6818
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
0700115A
IN
Other
Enumeration date
04/10/2018
Last updated
04/10/2018
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