Kelly L McClean, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4301073167 Issued in MI

Practice address

7300 Dexter-Ann Arbor Rd
Suite 110
Dexter, MI 48130-8598

Phone

(734) 426-2796

NPI assigned

Oct 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423094400000",
    "number": "1326129503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 DEXTER-ANN ARBOR RD",
            "address_2": "SUITE 110",
            "city": "DEXTER",
            "state": "MI",
            "postal_code": "481308598",
            "telephone_number": "734-426-2796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLEAN",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2015-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301073167",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301073167",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3502982",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roy Edgar Margenau III, D.D.S.
• Dennis Michael Marr, DDS
• Emily Anne Martin, DPT
• Zachary Gerald Martinchek, LLPC
• Mary Elizabeth Moenssen, D.D.S., M.S., P.C.
• Michael M McKee, MD
• Kiyah Meade
• Medsource LLC
• Seema Mehta, DO
• Meribeth Gandy Pezda LLC

• Dermatology Physician in Dexter, MI
• Providers in Dexter, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; 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.