Healthcare Provider Details

I. General information

NPI: 1750422531
Provider Name (Legal Business Name): JOHN RAYMOND MCGINNIS M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20176 HERITAGE DR
LAKEVILLE MN
55044-6855
US

IV. Provider business mailing address

605 E 131ST ST
BURNSVILLE MN
55337-3876
US

V. Phone/Fax

Practice location:
  • Phone: 612-839-4995
  • Fax:
Mailing address:
  • Phone: 952-890-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: