MEDICARE: COURTNEY MCCLINTIC 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	207Q00000X	Family Medicine Physician	82312	WI

General Provider Information

NPI Number	:	1467080739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MCCLINTIC MD

Provider Business Mailing Address
First Line	:	670 COUNTY ROAD A
Second Line	:
City	:	GREEN LAKE
State	:	WI
Zip	:	54941-8608
Country	:	US
Telephone Number	:	920-294-0100
Fax Number	:	920-294-0123

Provider Business Practice Location Address
First Line	:	670 COUNTY ROAD A
Second Line	:
City	:	GREEN LAKE
State	:	WI
Zip	:	54941-8608
Country	:	US
Telephone Number	:	920-294-0100
Fax Number	:	920-294-0123

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	07/28/2023

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