Healthcare Provider Details

I. General information

NPI: 1710914866
Provider Name (Legal Business Name): ALLEN DANIEL MCLEAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR ROAD C VA NORTHERN CALIFORNIA HEALTH CARE SYSTEM
MARTINEZ CA
94553
US

IV. Provider business mailing address

623 S. ALBERT ST.
MOUNT PROSPECT IL
60056
US

V. Phone/Fax

Practice location:
  • Phone: 395-372-2000
  • Fax:
Mailing address:
  • Phone: 847-398-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: