MEDICARE: MAGUIRE MEDICAL LLC

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
1	207R00000X	Internal Medicine Physician		OH
2	207Q00000X	Family Medicine Physician		OH

General Provider Information

NPI Number	:	1700397775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGUIRE MEDICAL LLC

Provider Business Mailing Address
First Line	:	2055 ALEXANDRIA WAY
Second Line	:
City	:	MACEDONIA
State	:	OH
Zip	:	44056-1998
Country	:	US
Telephone Number	:	330-468-3312
Fax Number	:	330-468-0602

Provider Business Practice Location Address
First Line	:	2055 ALEXANDRIA WAY
Second Line	:
City	:	MACEDONIA
State	:	OH
Zip	:	44056-1998
Country	:	US
Telephone Number	:	330-468-3312
Fax Number	:	330-468-0602

Authorized Official
Title or Position	:	TAX ID OWNER
Name	:	THOMAS M MAGUIRE
Credential	:	DO
Telephone Number	:	330-468-3312

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	10/18/2017

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Directions to “MAGUIRE MEDICAL LLC ” Practice Location

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