MEDICARE: RICHARD A MCLEAN 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	174400000X	Specialist	ME86503	FL

General Provider Information

NPI Number	:	1871571158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD A MCLEAN MD

Provider Business Mailing Address
First Line	:	14782 SW 176TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-6779
Country	:	US
Telephone Number	:	954-599-5172
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 NW 4TH ST
Second Line	:	SUITE 404
City	:	PLANTATION
State	:	FL
Zip	:	33317-2850
Country	:	US
Telephone Number	:	954-792-4880
Fax Number	:	954-792-4881

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/10/2007

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