Provider Demographics
NPI:1508831538
Name:CLEARY, PATRICK A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:CLEARY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 W ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2243
Mailing Address - Country:US
Mailing Address - Phone:765-284-7703
Mailing Address - Fax:765-284-6838
Practice Address - Street 1:1812 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2243
Practice Address - Country:US
Practice Address - Phone:765-284-7703
Practice Address - Fax:765-284-6838
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01038970A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100107160AMedicaid
INE11331Medicare UPIN
IN220930BMedicare ID - Type Unspecified
IN205870BMedicare PIN