Healthcare Provider Details

I. General information

NPI: 1053503466
Provider Name (Legal Business Name): DOUGLAS JUSTIN MCGUIRK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 N 5TH ST
TERRE HAUTE IN
47804-4010
US

IV. Provider business mailing address

221 S 6TH ST
TERRE HAUTE IN
47807-4214
US

V. Phone/Fax

Practice location:
  • Phone: 812-242-3005
  • Fax: 812-242-3054
Mailing address:
  • Phone: 812-242-3005
  • Fax: 812-242-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number49807
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number01065621A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: