Organization
MICHAEL R. MCCULLOUGH, D.O., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R. MCCULLOUGH D.O. (PHYSICIAN)
(972) 988-1588
Entity
Organization
Contact information
Practice address
643 S GREAT SOUTHWEST PKWY, SUITE 101, GRAND PRAIRIE, TX 75051-1056
(972) 602-0615
Mailing address
643 S GREAT SOUTHWEST PKWY, SUITE 101, GRAND PRAIRIE, TX 75051-1056
(972) 602-0615
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
H9682
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033519201
—
TX
Enumeration date
03/15/2011
Last updated
03/15/2011
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