Provider Demographics
NPI:1134161219
Name:MCLEAN, GREGG (MD)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-2963
Mailing Address - Fax:989-583-6831
Practice Address - Street 1:3875 BAY RD
Practice Address - Street 2:SUITE 45
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2417
Practice Address - Country:US
Practice Address - Phone:989-583-5150
Practice Address - Fax:989-583-6831
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM74750110Medicaid
MI3483448Medicaid
MIM74750110Medicaid