Individual
BRIAN MCCLENIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8317 CALUMET AVE, MUNSTER, IN 46321-1737
(219) 513-2333
(219) 513-2334
Mailing address
8317 CALUMET AVE, MUNSTER, IN 46321-1737
(219) 513-2333
(219) 513-2334
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01051695A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
01051695A
IN
208VP0014X
Interventional Pain Medicine Physician
Primary
01051695
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000494372
ANTHEM BCBS
IN
01
—
000000573813
ANTHEM BC/BS OF INDIANA
IN
05
—
036085894
—
IL
05
—
200251340A
—
IN
Enumeration date
05/08/2006
Last updated
04/07/2015
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