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General NPI Number Information
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NPI Number | 1821593708
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Entity Type | Individual
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Provider Name | ELIZABETH KATHERINE MACLEAN MD
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Gender | Female
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2689
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Country | US
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Telephone | 313-848-3642
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Fax |
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Provider Business Mailing Address
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Address Line | 2799 W GRAND BLVD DEPT OF
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-916-3284
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301511708
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 4301511708
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License Number State | MI
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