Provider Demographics
NPI:1134198773
Name:MCCLELLAN, PATRICK K (DO)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:K
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 1:35008 DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-1565
Mailing Address - Country:US
Mailing Address - Phone:586-727-3275
Mailing Address - Fax:586-727-3207
Practice Address - Street 1:35008 DIVISION RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1565
Practice Address - Country:US
Practice Address - Phone:586-727-3275
Practice Address - Fax:586-727-3207
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101005355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1006448Medicaid
MI1006448Medicaid