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Individual

BENJAMIN R MCCULLAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
1915 BISHOP LN, LOUISVILLE, KY 40218-1901
(502) 459-3338
(502) 459-7509
Mailing address
1915 BISHOP LN, LOUISVILLE, KY 40218-1901
(502) 459-3338
(502) 459-7509

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
00452
KY
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
243961
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300027424
IN
05
7100603540
KY
Enumeration date
06/30/2016
Last updated
07/02/2019
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