Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 50467 | WI |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 50467-20 | WI |
NPI | 1477686830 |
---|---|
Provider Name | Timothy M Mcculloch |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 27/01/2021 |