Provider Demographics
NPI:1770659146
Name:MCLEAN, SCOTT ALAN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:MCLEAN
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 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-936-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084147207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262260OtherBLUE CROSS-BLUE CROSS
MI472457310Medicaid
SM084147OtherCOMMERCIAL-COMMERCIAL NUMBER
SM084147OtherCHAMPUS-CHAMPUS
SM084147OtherCOMMERCIAL-COMMERCIAL NUMBER
MIH24068Medicare UPIN
700H262260OtherBLUE CROSS-BLUE CROSS