Individual
STEPHEN LEE MCCLELLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
N4656 LAKESHORE DR, KEWAUNEE, WI 54216-9794
(920) 388-0569
(920) 388-2760
Mailing address
PO BOX 191, KEWAUNEE, WI 54216-0191
(920) 388-0569
(920) 388-2760
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
22454-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043981900
—
FL
Enumeration date
01/31/2011
Last updated
01/31/2011
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