Basic Information
| Provider Information | |||||||||
| NPI: | 1104294354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCLAREN MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
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| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 611 COURT ST | ||||||||
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| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486618820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893457000 | ||||||||
| FaxNumber: | 9893457479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2015 | ||||||||
| LastUpdateDate: | 05/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | HARDIMON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8103421040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.