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NPI Code Detail

MEDICARE: JENNIFER M MCLELLAN M.D.

MEDICARE: JENNIFER M MCLELLAN 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
1207Q00000XFamily Medicine Physician35075113MOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548269657
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER M MCLELLAN M.D.
Provider Business Mailing Address
First Line : 935 STATE ROUTE 28
Second Line :
City : MILFORD
State : OH
Zip : 45150-1957
Country : US
Telephone Number : 513-831-5955
Fax Number : 513-831-5985
Provider Business Practice Location Address
First Line : 935 STATE ROUTE 28
Second Line :
City : MILFORD
State : OH
Zip : 45150-1957
Country : US
Telephone Number : 513-831-8555
Fax Number : 513-831-8685
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 10/28/2020

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