Provider Demographics
NPI:1437384922
Name:MCCLAVE, JULIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:L
Last Name:MCCLAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:LYNNE
Other - Last Name:MCCLAVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5800 LANDERBROOK DR STE 250
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4047
Mailing Address - Country:US
Mailing Address - Phone:440-544-1940
Mailing Address - Fax:440-544-1944
Practice Address - Street 1:5800 LANDERBROOK DR STE 250
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4047
Practice Address - Country:US
Practice Address - Phone:440-544-1940
Practice Address - Fax:440-544-1944
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35-098929208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0064680Medicaid
OHH091540Medicare PIN