MEDICARE: DR. JULIE L. MCCLAVE 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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	35-098929	OH

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	:	1437384922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE L. MCCLAVE M.D.

Provider Business Mailing Address
First Line	:	5800 LANDERBROOK DR STE 250
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4047
Country	:	US
Telephone Number	:	440-544-1940
Fax Number	:	440-544-1944

Provider Business Practice Location Address
First Line	:	5800 LANDERBROOK DR STE 250
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4047
Country	:	US
Telephone Number	:	440-544-1940
Fax Number	:	440-544-1944

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

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	02/07/2024

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