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General NPI Number Information
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NPI Number | 1467679191
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Entity Type | Organization
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Legal Business Name | ROBERT B MCCLURE DO
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 615 FULMER RD
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City | MISHAWAKA
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State | IN
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Zip | 46544-6911
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Country | US
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Telephone | 574-271-2558
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Fax |
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Provider Business Mailing Address
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Address Line | 615 FULMER RD
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City | MISHAWAKA
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State | IN
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Zip | 46544-6911
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT MCCLURE
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Credential |
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Telephone | 574-271-2558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02000983
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License Number State | IN
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