Healthcare Provider Details

I. General information

NPI: 1417097767
Provider Name (Legal Business Name): SEAN PATRICK MCBRIDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1000
  • Fax: 906-483-1270
Mailing address:
  • Phone: 906-483-1115
  • Fax: 906-483-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD 60225459
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301104468
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: