Provider Demographics
NPI:1194703439
Name:MCCLEARY, MICHAEL SEAN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SEAN
Last Name:MCCLEARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4907
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-4907
Mailing Address - Country:US
Mailing Address - Phone:515-241-5389
Mailing Address - Fax:515-241-4427
Practice Address - Street 1:1810 SW WHITE BIRCH CIRCLE
Practice Address - Street 2:STE 111
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-964-7115
Practice Address - Fax:515-964-7899
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0185686Medicaid
IA48338Medicare ID - Type Unspecified
IA0185686Medicaid