Organization
BAYSIDE ALLERGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES STEELE MCCLELLAN III MD (OWNER)
(231) 929-9090
Entity
Organization
Contact information
Practice address
447 MUNSON AVE, TRAVERSE CITY, MI 49686-3084
(231) 929-9090
(231) 929-9092
Mailing address
447 MUNSON AVE, TRAVERSE CITY, MI 49686-3084
(231) 929-9090
(231) 929-9092
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
JM073559
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030B812180
BCBS
MI
01
—
0P50390
MEDICARE GROUP NUMBER
MI
01
—
1124089073
JAMES S MCCLELLAN III MD
MI
05
—
1124089073
—
MI
01
—
1831388537
BAYSIDE ALLERGY PC
MI
01
—
DN0970
R/R MEDICARE GRP PTAN
MI
01
—
G38913
PRIORIITY NUMBER
MI
01
—
P00603999
R/R MEDICARE PTAN
MI
Enumeration date
10/18/2007
Last updated
10/05/2021
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