Individual
STEPHANIE L MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2746-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100039366
—
WI
Enumeration date
08/09/2011
Last updated
06/12/2025
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