MEDICARE: CLEMENT J MCDONALD

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	207R00000X	Internal Medicine Physician	01024115A	IN

General Provider Information

NPI Number	:	1952353815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEMENT J MCDONALD

Provider Business Mailing Address
First Line	:	PO BOX 78158
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-0158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 WISHARD BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2872
Country	:	US
Telephone Number	:	317-692-2300
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	05/31/2026

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