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General NPI Number Information
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NPI Number | 1174898126
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Entity Type | Organization
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Legal Business Name | MICHAEL K MCLEAN MD INC
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 2131 W 3RD ST
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City | LOS ANGELES
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State | CA
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Zip | 90057-1901
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Country | US
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Telephone | 213-484-7111
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Fax | 213-484-7489
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Provider Business Mailing Address
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Address Line | 5 HOLLAND STE 101
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City | IRVINE
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State | CA
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Zip | 92618-2568
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Country | US
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Telephone | 949-588-2190
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Fax | 949-588-2199
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL K MCLEAN
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Credential | MD
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Telephone | 949-588-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | A96165
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License Number State | CA
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