DR. CORNELL MCCULLOM D.D.S. M.D. NPI 1619124807

NPI Information

  • NPI: 1619124807
  • Provider Name: DR. CORNELL MCCULLOM, D.D.S., M.D.
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 820 E 87TH ST
    STE. 201
    CHICAGO, IL
    ZIP 60619
  • Phone: (773) 488-3738

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NPI Details

DR. Cornell Mccullom, D.D.S., M.D. is an oral and maxillofacial surgery dentist in Chicago, IL. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Cornell Mccullom, D.D.S., M.D. NPI is 1619124807. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

820 E 87TH ST
STE. 201
CHICAGO, IL
ZIP 60619-253
Phone: (773) 488-3738
Fax: (773) 874-6575

The NPI 1619124807 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 8/19/2008 and was last updated on 8/19/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial Surgery021001488ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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