Provider Demographics
NPI:1740287572
Name:MCCULLOUGH, WILLIAM MICHAEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:MCCULLOUGH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 PRESTIGE PL
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3794
Mailing Address - Country:US
Mailing Address - Phone:937-762-1305
Mailing Address - Fax:937-522-7513
Practice Address - Street 1:6438 WILMINGTON PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-848-4850
Practice Address - Fax:937-848-4858
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-01-13
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Provider Licenses
StateLicense IDTaxonomies
OH35-049602207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0062693Medicaid
OH0062693Medicaid
OHH083040Medicare PIN
OHMC0611741Medicare ID - Type Unspecified