Individual
JOSHUA MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, LAT
Contact information
Practice address
1440 MONROE ST RM B140E, MADISON, WI 53711-2051
(608) 224-9620
Mailing address
56 MEADOW DR APT 2312, FOND DU LAC, WI 54937-2309
(920) 763-3694
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9037-851
WI
2255A2300X
Athletic Trainer
1756-39
WI
Other
Enumeration date
04/20/2016
Last updated
06/08/2021
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