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1134380223

NPI Code Detail

MEDICARE: DR. KATRINA MARIE KANDRA MCLELLAN MD

MEDICARE: DR. KATRINA MARIE KANDRA MCLELLAN MD

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	208100000X	Physical Medicine & Rehabilitation Physician	D0069137	MD
2	208100000X	Physical Medicine & Rehabilitation Physician	0101245599	VA

General Provider Information

NPI Number	:	1134380223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATRINA MARIE KANDRA MCLELLAN MD

Provider Business Mailing Address
First Line	:	PO BOX 74008272
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-8272
Country	:	US
Telephone Number	:	702-899-0595
Fax Number	:	702-977-1496

Provider Business Practice Location Address
First Line	:	305 COLLEGE PKWY
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-2903
Country	:	US
Telephone Number	:	872-231-3162
Fax Number	:

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	10/01/2025

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Directions to “ DR. KATRINA MARIE KANDRA MCLELLAN MD” Practice Location

Language	Start Address	Practice Location

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