Provider Demographics
NPI:1932526993
Name:CONWAY MCLEAN DPM PC
Entity Type:Organization
Organization Name:CONWAY MCLEAN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONWAY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:906-225-7707
Mailing Address - Street 1:700 W WASHINGTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4164
Mailing Address - Country:US
Mailing Address - Phone:906-225-7707
Mailing Address - Fax:906-225-7710
Practice Address - Street 1:700 W WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4164
Practice Address - Country:US
Practice Address - Phone:906-225-7707
Practice Address - Fax:906-225-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICM002555213E00000X, 332B00000X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CM002555OtherLICENSE