MEDICARE: MR. JOHN W MCCLEAN 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	207RX0202X	Medical Oncology Physician	036059602	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	340017813	OTHER	IL	RR MEDICARE PROV #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04823538	OTHER	IL	BCBS GROUP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	IL0103	OTHER	IL	JOHN DEERE PROV #
4	039664	OTHER	IL	HEALTH ALLIANCE PROV #
6	693762	OTHER	IL	HEALTHLINK PROV #

General Provider Information

NPI Number	:	1548268204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN W MCCLEAN M.D.

Provider Business Mailing Address
First Line	:	834 N SEMINARY ST
Second Line	:	STE 502
City	:	GALESBURG
State	:	IL
Zip	:	61401-2852
Country	:	US
Telephone Number	:	309-343-2262
Fax Number	:	309-343-2081

Provider Business Practice Location Address
First Line	:	834 N SEMINARY ST
Second Line	:	STE 502
City	:	GALESBURG
State	:	IL
Zip	:	61401-2852
Country	:	US
Telephone Number	:	309-343-2262
Fax Number	:	309-343-2081

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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