Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11017271A | IN |
Y | 207Q00000X | Family Doctor | 71183 | WI |
N | 207Q00000X | Family Doctor | MD-43530 | IA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD-43530 | IA |
NPI | 1144668757 |
---|---|
Provider Name | Mark D Mceleney |
First Address | Eau Claire, WI 54702-1510 |
Second Address | La Crosse, WI 54601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2013 |
Last Update Date | 16/09/2020 |