Healthcare Provider Details

I. General information

NPI: 1558963546
Provider Name (Legal Business Name): MCLEAN COMMUNITY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 N LAPEER RD STE B & C
NORTH BRANCH MI
48461-9660
US

IV. Provider business mailing address

5830 N LAPEER RD STE B & C
NORTH BRANCH MI
48461-9660
US

V. Phone/Fax

Practice location:
  • Phone: 810-270-9301
  • Fax: 810-270-9302
Mailing address:
  • Phone: 810-270-9301
  • Fax: 810-270-9302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NIKOLE MCLEAN
Title or Position: OWNER
Credential: NP
Phone: 810-270-9301