MEDICARE: PATRICK K. MCCLELLAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101005355	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134198773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK K. MCCLELLAN D.O.

Provider Business Mailing Address
First Line	:	35008 DIVISION RD
Second Line	:
City	:	RICHMOND
State	:	MI
Zip	:	48062-1565
Country	:	US
Telephone Number	:	586-727-3275
Fax Number	:	586-727-3207

Provider Business Practice Location Address
First Line	:	35008 DIVISION RD
Second Line	:
City	:	RICHMOND
State	:	MI
Zip	:	48062-1565
Country	:	US
Telephone Number	:	586-727-3275
Fax Number	:	586-727-3207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/08/2007

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