Individual
BRUCE A MCLELLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 115, PEORIA, IL 61614-5098
(309) 691-2903
(309) 691-2909
Mailing address
5401 N KNOXVILLE AVE STE 115, PEORIA, IL 61614-5068
(309) 691-2903
(309) 691-2909
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036056311
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036056311
—
IL
01
—
P05833
PTAN
IL
Enumeration date
10/10/2006
Last updated
04/15/2014
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