Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | JM073559 | MI |
NPI | 1124089073 |
---|---|
Provider Name | Dr. James Steele Mcclellan III |
First Address | Traverse City, MI 49686-3084 |
Second Address | Traverse City, MI 49686-3084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 14/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G38913 | (02) | MI |