Healthcare Provider Details

I. General information

NPI: 1063627230
Provider Name (Legal Business Name): MICHAEL DOUGLAS MCCLEARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13838 TILDEN RD
WINTER GARDEN FL
34787-5318
US

IV. Provider business mailing address

25 W CRYSTAL LAKE ST STE 200
ORLANDO FL
32806-4476
US

V. Phone/Fax

Practice location:
  • Phone: 407-287-9113
  • Fax: 407-480-4556
Mailing address:
  • Phone: 407-254-2500
  • Fax: 407-423-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberME98424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: