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NPI Code Detail

MEDICARE: DR. LISA MCCLELLAN MD

MEDICARE: DR. LISA MCCLELLAN 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
1207Q00000XFamily Medicine Physician25023AZ

General Provider Information

NPI Number : 1801888763
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA MCCLELLAN MD
Provider Business Mailing Address
First Line : PO BOX 31001-0698
Second Line :
City : PASADENA
State : CA
Zip : 91110-0698
Country : US
Telephone Number : 602-263-1200
Fax Number : 602-200-5383
Provider Business Practice Location Address
First Line : 500 W THOMAS RD
Second Line : STE 870
City : PHOENIX
State : AZ
Zip : 85013-4218
Country : US
Telephone Number : 877-809-0509
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 02/07/2018

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Directions to “ DR. LISA MCCLELLAN MD” Practice Location

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