Healthcare Provider Details

I. General information

NPI: 1780773499
Provider Name (Legal Business Name): MICHAEL L MCGRADY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8808 BALBOA AVE
SAN DIEGO CA
92123-1592
US

IV. Provider business mailing address

149 E SIMPSON ST
ALLIANCE OH
44601-4219
US

V. Phone/Fax

Practice location:
  • Phone: 619-645-0155
  • Fax: 619-645-0193
Mailing address:
  • Phone: 330-823-3856
  • Fax: 330-829-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-038216
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: