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General NPI Number Information
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NPI Number | 1114367737
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Entity Type | Individual
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Provider Name | SUSAN MCLAREN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 10909 HANNAN RD
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City | ROMULUS
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State | MI
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Zip | 48174-1383
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Country | US
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Telephone | 734-941-1142
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Fax | 734-955-6973
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Provider Business Mailing Address
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Address Line | 45515 MUIRFIELD DR
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City | CANTON
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State | MI
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Zip | 48188-1098
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Country | US
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Telephone | 734-748-9399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601001901
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License Number State | MI
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