Individual
DR. MICHAEL REID MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
643 S GREAT SOUTHWEST PKWY, SUITE 101, GRAND PRAIRIE, TX 75051-1056
(972) 988-1588
(972) 602-0615
Mailing address
643 S GREAT SOUTHWEST PKWY, SUITE 101, GRAND PRAIRIE, TX 75051-1056
(972) 988-1588
(972) 602-0615
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
H9682
TX
207VX0000X
Obstetrics Physician
Primary
H9682
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033519201
TPI
TX
05
—
033519201
—
TX
01
—
10028878
AMERIGROUP ID
TX
05
—
1275832362
—
TX
01
—
4250747
AETNA ID
TX
01
—
G74V
BLUE CROSS BLUE SHIELD ID
TX
Enumeration date
06/24/2006
Last updated
01/18/2022
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