Provider Demographics
NPI:1205821667
Name:MCLELLAN, DANIEL S (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:MCLELLAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2910 CENTRE POINTE DR
Mailing Address - Street 2:35-121A
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1182
Mailing Address - Country:US
Mailing Address - Phone:651-855-2109
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:CHILDRENS SPECIALITY CLINIC-INTEGRATIVE MEDICINE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-7888
Practice Address - Fax:612-813-7199
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN28292208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F78715Medicare UPIN