Provider Demographics
NPI:1265727333
Name:MCLEMORE, MICHAEL STEVEN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEVEN
Last Name:MCLEMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:54 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3909
Mailing Address - Country:US
Mailing Address - Phone:516-488-1313
Mailing Address - Fax:516-488-1368
Practice Address - Street 1:2220 N SCREENLAND DR STE 101
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1137
Practice Address - Country:US
Practice Address - Phone:323-935-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA127019207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281873401Medicaid
TX8CW235OtherBCBS
TXP00990939OtherRR MEDICARE
TX281873401Medicaid