Individual
LORI A MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
Mailing address
6400 CLAYTON RD, STE 110, SAINT LOUIS, MO 63117-1850
(314) 645-4434
(314) 645-3801
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085005433
IL
363AM0700X
Medical Physician Assistant
2002001000
MO
Other
Enumeration date
04/08/2008
Last updated
08/31/2022
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