Healthcare Provider Details

I. General information

NPI: 1750509303
Provider Name (Legal Business Name): MICHAEL THOMAS MCGINN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL MCGINN

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 NW 7TH ST
MIAMI FL
33125-4241
US

IV. Provider business mailing address

8745 SW 56TH PL
COOPER CITY FL
33328-5917
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-4044
  • Fax: 305-642-2320
Mailing address:
  • Phone: 865-406-3668
  • Fax: 305-642-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: