Provider Demographics
NPI:1902266836
Name:MACLACHLAN, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MACLACHLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 COUNTY ROAD 6
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:MN
Mailing Address - Zip Code:55356-9658
Mailing Address - Country:US
Mailing Address - Phone:952-476-2422
Mailing Address - Fax:
Practice Address - Street 1:3565 COUNTY ROAD 6
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:MN
Practice Address - Zip Code:55356-9658
Practice Address - Country:US
Practice Address - Phone:952-476-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLC679198171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications