Provider Demographics
NPI:1760839849
Name:HOWELL-MCLEAN, CAILLY (MD)
Entity Type:Individual
Prefix:
First Name:CAILLY
Middle Name:
Last Name:HOWELL-MCLEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAILLY
Other - Middle Name:
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2213 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43620-1402
Mailing Address - Country:US
Mailing Address - Phone:419-251-2415
Mailing Address - Fax:
Practice Address - Street 1:2213 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1402
Practice Address - Country:US
Practice Address - Phone:419-251-2415
Practice Address - Fax:419-251-2422
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35136119208000000X
MI4301109490390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0358446Medicaid