Provider Demographics
NPI:1215131701
Name:MCCULLOUGH, KIRK A (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:A
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3651 COLLEGE BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1910
Mailing Address - Country:US
Mailing Address - Phone:913-319-7600
Mailing Address - Fax:913-253-1702
Practice Address - Street 1:3651 COLLEGE BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1910
Practice Address - Country:US
Practice Address - Phone:913-319-7600
Practice Address - Fax:913-253-1702
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026069207XX0004X, 207XX0005X
OH35.121283207XX0004X, 207XX0005X
KS04-36662207XX0004X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1559Medicaid
NC5919974Medicaid
NC0397730007Medicare NSC
NCNC6155AMedicare PIN