Healthcare Provider Details

I. General information

NPI: 1376604488
Provider Name (Legal Business Name): CLEMENT JOSEPH MCDONALD III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/21/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 RONALD REAGAN PKWY STE 255
AVON IN
46123-6910
US

IV. Provider business mailing address

10201 N ILLINOIS ST STE 110
CARMEL IN
46290-1172
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-2255
  • Fax: 317-819-0044
Mailing address:
  • Phone: 317-819-4516
  • Fax: 317-819-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01056684A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: