Mccullough, Kim Leslie

Mccullough, Kim Leslie is an sole proprietor health care provider with primary practice located at 550 Osborn Blvd Suite 2600, Sault Sainte Marie MI 49783-1899. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Mccullough, Kim Leslie can be contacted via phone (906) 635-1048.

Contact Information

Primary practice address
550 Osborn Blvd Suite 2600 Sault Sainte Marie MI 49783-1899
Phone: (906) 635-1048
Fax: (906) 635-3103
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X KM405465 Michigan

Profile Details

NPI number 1194777680
LBN Legal business name Mccullough, Kim Leslie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 16th, 2006
Last updated Feb 22nd, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194777680 NPPES
Michigan Other 382967127 TAX IDENTIFICATION
Michigan MEDICAID 2698385 TAX IDENTIFICATION

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