Healthcare Provider Details

I. General information

NPI: 1093891400
Provider Name (Legal Business Name): MICHAEL E MCCLURE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 411
ORLANDO FL
32804-4644
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 411
ORLANDO FL
32804-4644
US

V. Phone/Fax

Practice location:
  • Phone: 251-665-8150
  • Fax: 251-665-8155
Mailing address:
  • Phone: 407-303-1373
  • Fax: 407-303-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3675849
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME104923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: