MEDICARE: DENNIS ROBERT MCCLAIN 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	208D00000X	General Practice Physician	01030085A	IN
2	2083X0100X	Occupational Medicine Physician	01030085A	IN

General Provider Information

NPI Number	:	1417051053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS ROBERT MCCLAIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	3605 NORTHGATE CT STE 110
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-6400
Country	:	US
Telephone Number	:	812-949-5749
Fax Number	:	812-929-5794

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	08/30/2024

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