Healthcare Provider Details

I. General information

NPI: 1487657896
Provider Name (Legal Business Name): DEBRA R MCCLAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E DAY RD STE 280
MISHAWAKA IN
46545-3452
US

IV. Provider business mailing address

270 E DAY RD STE 280
MISHAWAKA IN
46545-3452
US

V. Phone/Fax

Practice location:
  • Phone: 574-271-0268
  • Fax: 574-271-0395
Mailing address:
  • Phone: 574-271-0268
  • Fax: 574-271-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01028643
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: