Individual
SUSAN D MCCULLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2232 GRAND AVE, FORT MYERS, FL 33901-3717
(239) 344-2341
(239) 334-7518
Mailing address
PO BOX 1357, FORT MYERS, FL 33902-1357
(239) 278-3600
(239) 278-3857
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME86366
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1483313
UNITED
FL
05
—
265855100
—
FL
01
—
62808
BLUE CROSS
FL
01
—
7768378
AETNA
FL
Enumeration date
11/02/2005
Last updated
04/30/2010
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