Provider Demographics
NPI:1871737239
Name:MCCLINTOCK, MICHAEL LEWIS JR (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEWIS
Last Name:MCCLINTOCK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE #915
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-2117
Mailing Address - Fax:312-563-2607
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE #915
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-2117
Practice Address - Fax:312-563-2607
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2013-07-25
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Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.132924207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology