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Individual

MRS. LISA RUTH MCLEAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
17500 FEDERAL DR STE 750, ALLEN PARK, MI 48101-3656
(313) 982-1370
(313) 982-1376
Mailing address
17500 FEDERAL DR STE 750, ALLEN PARK, MI 48101-3656
(313) 982-1370
(313) 982-1376

Taxonomy

Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
5601008938
MI
363AM0700X
Medical Physician Assistant
Primary
5601008938
MI
363AM0700X
Medical Physician Assistant
PA53731
CA

Other

Enumeration date
10/03/2016
Last updated
04/29/2021
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