| Doctor Name: | MRS. METTISA R. K. MCLEOD |
| NPI Number: | 1235245481 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 036113800 |
| Business Practice Address: | 501 Belt Line Rd Suite 20-d Collinsville, IL - 622344410 |
| Business Phone Number: | 6183436005 |
| Business Fax Number: | 6183439114 |
| Mailing Address: | 4500 Memorial Drive, Memorial Hospital Credentialing Dept BELLEVILLE |
| State: | IL |
| Postal Code: | 622264061 |
| Phone Number: | 6182574644 |
| Fax Number: | 6182576946 |
| NPI Enumeration Date: | 08/21/2006 |
| NPI Last Update Date: | 06/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0000X |
| License Number: | 036113800 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adolescent Medicine |
| Taxonomy Definition: | A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs. |