Healthcare Provider Details

I. General information

NPI: 1265727333
Provider Name (Legal Business Name): MICHAEL STEVEN MCLEMORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N SCREENLAND DR STE 101
BURBANK CA
91505-1137
US

IV. Provider business mailing address

54 NEW HYDE PARK RD
GARDEN CITY NY
11530-3909
US

V. Phone/Fax

Practice location:
  • Phone: 323-935-8800
  • Fax:
Mailing address:
  • Phone: 516-488-1313
  • Fax: 516-488-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA127019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: