Provider Demographics
NPI:1548268204
Name:MCCLEAN, JOHN W (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:MCCLEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:834 N SEMINARY ST
Mailing Address - Street 2:STE 502
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2852
Mailing Address - Country:US
Mailing Address - Phone:309-343-2262
Mailing Address - Fax:309-343-2081
Practice Address - Street 1:834 N SEMINARY ST
Practice Address - Street 2:STE 502
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2852
Practice Address - Country:US
Practice Address - Phone:309-343-2262
Practice Address - Fax:309-343-2081
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036059602207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04823538OtherBCBS GROUP #
IL036059602Medicaid
ILIL0103OtherJOHN DEERE PROV #
IL039664OtherHEALTH ALLIANCE PROV #
IL340017813OtherRR MEDICARE PROV #
IL693762OtherHEALTHLINK PROV #
IL039664OtherHEALTH ALLIANCE PROV #
ILIL0103OtherJOHN DEERE PROV #