| Doctor Name: | WAYNE M MCCULLOUGH |
| NPI Number: | 1033284179 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 1939 |
| Business Practice Address: | 21813 Cappel Ln Frankfort, IL - 604232275 |
| Business Phone Number: | 9785496818 |
| Business Fax Number: | 8476740892 |
| Mailing Address: | 21813 Cappel Ln, FRANKFORT |
| State: | IL |
| Postal Code: | 604232275 |
| Phone Number: | 9785496818 |
| Fax Number: | 8476740892 |
| NPI Enumeration Date: | 11/22/2006 |
| NPI Last Update Date: | 09/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 1939 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |