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: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 CONCORD RD STE A
LAFAYETTE IN
47909-2710
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1008
US

V. Phone/Fax

Practice location:
  • Phone: 765-477-7436
  • Fax: 765-477-1245
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

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: