Provider Demographics
NPI:1780753988
Name:MCCULLOUGH, STEVEN J (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636961
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6961
Mailing Address - Country:US
Mailing Address - Phone:270-538-5596
Mailing Address - Fax:270-538-5597
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 304
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-538-5596
Practice Address - Fax:270-538-5597
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY02706207RN0300X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64069461Medicaid
KY64069461Medicaid
KY0257922Medicare PIN
KYK082750Medicare PIN