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General NPI Number Information
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NPI Number | 1831388537
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Entity Type | Organization
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Legal Business Name | BAYSIDE ALLERGY, P.C.
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 447 MUNSON AVE
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-3084
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Country | US
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Telephone | 231-929-9090
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Fax | 231-929-9092
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Provider Business Mailing Address
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Address Line | 447 MUNSON AVE
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-3084
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Country | US
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Telephone | 231-929-9090
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Fax | 231-929-9092
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES STEELE MCCLELLAN III
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Credential | MD
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Telephone | 231-929-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | JM073559
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License Number State | MI
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