IndividualActive
Cornell Mccullom, D.D.S., M.D.
NPI 1619124807 · Oral and Maxillofacial Surgery (Dentist) · Chicago, IL
Provider details
- NPI number
- 1619124807
- Entity type
- Individual
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Credential
- D.D.S., M.D.
- Sex
- Male
- Sole proprietor
- No
- License
- 021001488 (IL)
Specialties & taxonomies
Dental Providers
Practice location
820 E 87th St
Ste. 201
Chicago, IL 60619-6253
Phone: (773) 488-3738
Fax: (773) 874-6575
Approximate (ZIP-level) locationGet directions
Mailing address
820 E 87th St
Chicago, IL 60619-6253
Registry dates
- Enumerated
- 2008-08-19
- Last updated
- 2008-08-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.