Individual
MR. KEITH MICHAEL MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
700 W IRONWOOD DR STE 175, COEUR D ALENE, ID 83814-4401
(208) 625-6300
(208) 625-6301
Mailing address
700 W IRONWOOD DR STE 175, COEUR D ALENE, ID 83814-4401
(208) 625-6309
(208) 625-6310
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1818
ID
Other
Enumeration date
09/19/2019
Last updated
08/03/2025
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