Provider Demographics
NPI:1902227705
Name:MCCLANAHAN, MICHAEL F (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:F
Last Name:MCCLANAHAN
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:650 UNIVERSITY AVE #200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-922-8400
Mailing Address - Fax:916-922-8488
Practice Address - Street 1:650 UNIVERSITY AVE #200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-922-8400
Practice Address - Fax:916-922-8488
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant