Healthcare Provider Details

I. General information

NPI: 1932526993
Provider Name (Legal Business Name): CONWAY MCLEAN DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 09/06/2023
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W WASHINGTON ST STE B
MARQUETTE MI
49855-4164
US

IV. Provider business mailing address

700 W WASHINGTON ST STE B
MARQUETTE MI
49855-4164
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-7707
  • Fax: 906-225-7710
Mailing address:
  • Phone: 906-225-7707
  • Fax: 906-225-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberCM002555
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberCM002555
License Number StateMI

VIII. Authorized Official

Name: CONWAY T MCLEAN
Title or Position: PHYSICIAN / OWNER
Credential: DPM
Phone: 906-225-7707