Provider Demographics
NPI:1053644450
Name:MCCLURE, MICHAEL W
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2333
Mailing Address - Country:US
Mailing Address - Phone:307-672-8638
Mailing Address - Fax:
Practice Address - Street 1:1544 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2333
Practice Address - Country:US
Practice Address - Phone:307-672-8638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator