Individual
KEVIN MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5301 E HURON RIVER DR, YPSILANTI, MI 48197-1051
(734) 712-4760
(734) 786-4977
Mailing address
5301 E HURON RIVER DR, YPSILANTI, MI 48197-1051
(734) 712-4760
(734) 786-4977
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704303167
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704303167
STATE OF MICHIGAN
MI
Enumeration date
09/24/2014
Last updated
03/30/2021
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