Healthcare Provider Details

I. General information

NPI: 1881785590
Provider Name (Legal Business Name): JIM I MCCLURE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N GREENLEAF ST SUITE 100
GURNEE IL
60031-3393
US

IV. Provider business mailing address

135 N GREENLEAF ST SUITE 100
GURNEE IL
60031-3393
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-7223
  • Fax: 847-244-7247
Mailing address:
  • Phone: 847-244-7223
  • Fax: 847-244-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: