MEDICARE: DR. MARILYN MEADE MCCLUSKEY M.D.

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	174400000X	Specialist	H5927	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104907492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN MEADE MCCLUSKEY M.D.

Provider Business Mailing Address
First Line	:	1701 MEADOWBROOK DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-2840
Country	:	US
Telephone Number	:	512-345-9476
Fax Number	:

Provider Business Practice Location Address
First Line	:	11111 RESEARCH BLVD
Second Line	:	STE 170
City	:	AUSTIN
State	:	TX
Zip	:	78759-5264
Country	:	US
Telephone Number	:	512-338-5222
Fax Number	:	512-338-5229

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/06/2011

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