MEDICARE: MICHAEL E MCCLURE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	3675849	AL
2	2086S0122X	Plastic and Reconstructive Surgery Physician	ME104923	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51592621	OTHER	AL	BCBS - 1720 CENTER ST
2	51592834	OTHER	AL	3401 MED PK DR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	51593305	OTHER	AL	2451 FILLINGIM
5	51592825	OTHER	AL	575 STANTON RD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093891400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E MCCLURE MD

Provider Business Mailing Address
First Line	:	2501 N ORANGE AVE STE 411
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4644
Country	:	US
Telephone Number	:	407-303-1373
Fax Number	:	407-303-0852

Provider Business Practice Location Address
First Line	:	2501 N ORANGE AVE STE 411
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4644
Country	:	US
Telephone Number	:	251-665-8150
Fax Number	:	251-665-8155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	03/06/2019

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Directions to “ MICHAEL E MCCLURE MD” Practice Location

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