Provider Demographics
NPI:1093891400
Name:MCCLURE, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 411
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4644
Mailing Address - Country:US
Mailing Address - Phone:407-303-1373
Mailing Address - Fax:407-303-0852
Practice Address - Street 1:2501 N ORANGE AVE STE 411
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4644
Practice Address - Country:US
Practice Address - Phone:251-665-8150
Practice Address - Fax:251-665-8155
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3675849208600000X
FLME1049232086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51592621OtherBCBS - 1720 CENTER ST
AL51592834Other3401 MED PK DR
MS09157347Medicaid
AL51593305Other2451 FILLINGIM
AL51592825Other575 STANTON RD
AL51592834Other3401 MED PK DR