Individual
PHILIP K MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
676 N SAINT CLAIR ST STE 1510, CHICAGO, IL 60611-2995
(312) 695-3680
(312) 926-3709
Mailing address
676 N SAINT CLAIR ST STE 1510, CHICAGO, IL 60611-2995
(312) 695-3680
(312) 695-1959
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036049877
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635513
BCBS PROVIDER NUMBER
IL
Enumeration date
04/26/2006
Last updated
01/21/2021
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