Stephen Lee McClellan, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

22454-20 Issued in WI

Practice address

N4656 Lakeshore Dr
Kewaunee, WI 54216-9794

Phone

(920) 388-0569

Fax

(920) 388-2760

NPI assigned

Jan 31, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bay Pathology Associates PA

  • Anatomic Pathology & Clinical Pathology Physician
  • Panama City, FL
  • NPI 1053329375
  NPD (past)
• Bay Pharmacokinetic Associates LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Panama City, FL
  • NPI 1841200094
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296432000000",
    "number": "1023314549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "city": "KEWAUNEE",
            "state": "WI",
            "postal_code": "542160191",
            "telephone_number": "920-388-0569",
            "fax_number": "920-388-2760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N4656 LAKESHORE DR",
            "city": "KEWAUNEE",
            "state": "WI",
            "postal_code": "542169794",
            "telephone_number": "920-388-0569",
            "fax_number": "920-388-2760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLELLAN",
        "first_name": "STEPHEN",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-31",
        "last_updated": "2011-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WI",
            "license": "22454-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043981900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark A Letter, DDS
• Beth Mackintosh
• Lauren E Manston, MASTER DEGREE
• Mark a Letter DDS SC
• Mercedes Marie Marrero
• Sarah McKnight, M.S.
• Melissa Ann Melnarik, LPN
• Lissa Anne Miller
• Bonnie S Mueller-Waigand, PA
• Carol Jean Mueller, LPN

• Anatomic Pathology & Clinical Pathology Physician in Kewaunee, WI
• Providers in Kewaunee, WI by specialty
• Anatomic Pathology & Clinical Pathology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.