Provider Demographics
NPI:1720112535
Name:MCLAREN HEALTH MANAGEMENT GROUP
Entity Type:Organization
Organization Name:MCLAREN HEALTH MANAGEMENT GROUP
Other - Org Name:MCLAREN HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP - CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:LOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-496-8633
Mailing Address - Street 1:PO BOX 775440
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5440
Mailing Address - Country:US
Mailing Address - Phone:810-496-8850
Mailing Address - Fax:810-496-8655
Practice Address - Street 1:1515 CAL DR
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-9016
Practice Address - Country:US
Practice Address - Phone:810-496-8850
Practice Address - Fax:810-496-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 333600000X, 3336C0004X, 3336S0011X
MI53010062563336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2354431Medicaid
2042741OtherPK
1308080002Medicare NSC