Provider Demographics
NPI:1881354678
Name:MCCLAIN, HARRY LEWIS IV
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:LEWIS
Last Name:MCCLAIN
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2647
Mailing Address - Country:US
Mailing Address - Phone:312-678-0677
Mailing Address - Fax:
Practice Address - Street 1:1905 W 19TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2647
Practice Address - Country:US
Practice Address - Phone:312-678-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty