Healthcare Provider Details

I. General information

NPI: 1780866855
Provider Name (Legal Business Name): LISA ANN MCGINNITY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18301 N 79TH AVE STE 150
GLENDALE AZ
85308-6045
US

IV. Provider business mailing address

645 E MISSOURI AVE STE 300
PHOENIX AZ
85012-1351
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-1520
  • Fax:
Mailing address:
  • Phone: 602-262-8900
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number40603
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: