Healthcare Provider Details

I. General information

NPI: 1598715732
Provider Name (Legal Business Name): JOSEPH ALLEN MCLEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 E SUPERIOR ST
DULUTH MN
55804-2545
US

IV. Provider business mailing address

PO BOX 80257
MILWAUKEE WI
53208-8004
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-4500
  • Fax: 218-249-4555
Mailing address:
  • Phone: 414-935-8000
  • Fax: 414-344-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: