Individual
DR. MITCHELL ROBERT MCCLEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 944-8660
(317) 944-1289
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01082310A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11018640A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201369360
—
IN
01
—
264910360
MEDICARE
IN
Enumeration date
05/12/2016
Last updated
01/23/2023
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