Healthcare Provider Details

I. General information

NPI: 1417051053
Provider Name (Legal Business Name): DENNIS ROBERT MCCLAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 NORTHGATE CT STE 110
NEW ALBANY IN
47150-6400
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 812-949-5749
  • Fax: 812-929-5794
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01030085A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number01030085A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: