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NPI Code Detail

MEDICARE: DR. JEREMY BOONE MCCUE MD

MEDICARE: DR. JEREMY BOONE MCCUE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician9969AWY
22085R0202XDiagnostic Radiology Physician53966CO
32085R0202XDiagnostic Radiology Physician27947NE
42085R0202XDiagnostic Radiology Physician42576-20WI

General Provider Information

NPI Number : 1033187927
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMY BOONE MCCUE MD
Provider Business Mailing Address
First Line : 2941 S RIDGE RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-5517
Country : US
Telephone Number : 920-336-4096
Fax Number : 920-336-8093
Provider Business Practice Location Address
First Line : 2941 S RIDGE RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-5517
Country : US
Telephone Number : 920-336-4096
Fax Number : 920-336-8093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 05/20/2016

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