Individual
STACIE D MCCLANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.R.
Contact information
Practice address
680 N. LAKE SHORE DRIVE, SUITE 1425, CHICAGO, IL 60611
(312) 867-9500
Mailing address
680 N. LAKE SHORE DRIVE, SUITE 1425, CHICAGO, IL 60611
(312) 867-9500
(312) 674-7501
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
036-106591
IL
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
036-106591
IL
Other
Enumeration date
07/17/2006
Last updated
04/25/2014
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