Healthcare Provider Details

I. General information

NPI: 1578539052
Provider Name (Legal Business Name): WILLIAM MICHAEL MAGUIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 3RD ST
DELTA CO
81416-2815
US

IV. Provider business mailing address

16510 30TH AVE N
PLYMOUTH MN
55447-1819
US

V. Phone/Fax

Practice location:
  • Phone: 979-874-7681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39142
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number46155
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: