MEDICARE: DR. NELSON MCLEMORE 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	208100000X	Physical Medicine & Rehabilitation Physician	036.084437	IL

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
2	363236791	OTHER	IL	TAX ID #

General Provider Information

NPI Number	:	1164590725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON MCLEMORE M.D.

Provider Business Mailing Address
First Line	:	26W171 ROOSEVELT RD
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-6078
Country	:	US
Telephone Number	:	630-909-7000
Fax Number	:	630-909-7001

Provider Business Practice Location Address
First Line	:	13259 S CENTRAL AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2601
Country	:	US
Telephone Number	:	630-239-6050
Fax Number	:	708-597-6243

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	03/07/2018

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