Individual
CHRISTOPHER S. MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
112 SEARS AVE, LOUISVILLE, KY 40207-5014
(502) 238-2163
(502) 238-2173
Mailing address
2425 LIME KILN LN, LOUISVILLE, KY 40222-3462
(502) 899-7163
(502) 897-9963
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34957
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000225513
ANTHEM / NCMA
KY
01
—
000026447N
HUMANA / NCMA
KY
01
—
012817
SIHO / NCMA
KY
01
—
110235213
RAILROAD MEDICARE
KY
05
—
200381960
—
IN
01
—
2439608000
PASSPORT ADVANTAGE / NCMA
KY
05
—
64046287
—
KY
Enumeration date
04/19/2006
Last updated
03/04/2014
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