Provider Demographics
NPI:1003831207
Name:MCCLAID, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:MCCLAID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1724 W PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-1940
Mailing Address - Country:US
Mailing Address - Phone:574-546-3045
Mailing Address - Fax:574-546-2716
Practice Address - Street 1:1724 W PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1940
Practice Address - Country:US
Practice Address - Phone:574-546-3045
Practice Address - Fax:574-546-2716
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01061391A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200811840Medicaid
IN200811840Medicaid
IN206320DMedicare PIN