Provider Demographics
NPI:1558331389
Name:MCCLELLAN, CURT C (DO)
Entity Type:Individual
Prefix:
First Name:CURT
Middle Name:C
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 AVENUE O
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-9601
Mailing Address - Country:US
Mailing Address - Phone:319-376-2134
Mailing Address - Fax:319-376-2188
Practice Address - Street 1:5409 AVENUE O
Practice Address - Street 2:PO BOX 174
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-0174
Practice Address - Country:US
Practice Address - Phone:319-376-2134
Practice Address - Fax:319-376-2188
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3551208000000X
IADO03551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA504130OtherIOWA HEALTH SOLUTIONS
IA70309OtherWELLMARK
IA1425371Medicaid
IA01ZHOtherUHCRV
IA504130OtherIOWA HEALTH SOLUTIONS
IA01ZHOtherUHCRV