Mccullough, Wayne M

Mccullough, Wayne M is an sole proprietor health care provider with primary practice located at 21813 Cappel Ln , Frankfort IL 60423-2275. He recently has 4 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine, Podiatric Medicine & Surgery Service Providers / Foot Surgery, Podiatric Medicine & Surgery Service Providers / Sports Medicine. Podiatric Medicine & Surgery Service Providers / Podiatrist is his primary health care specialty. Mccullough, Wayne M can be contacted via phone (978) 549-6818.

Contact Information

Primary practice address
21813 Cappel Ln Frankfort IL 60423-2275
Phone: (978) 549-6818
Fax: (847) 674-0892
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 1939 Massachusetts
Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine 213EP1101X 1939 Massachusetts
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X 1939 Massachusetts
Podiatric Medicine & Surgery Service Providers / Sports Medicine 213ES0000X 1939 Massachusetts

Profile Details

NPI number 1033284179
LBN Legal business name Mccullough, Wayne M
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 22nd, 2006
Last updated Sep 21st, 2015 - about 11 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 1033284179 NPPES
Massachusetts MEDICAID 0363037

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