Healthcare Provider Details

I. General information

NPI: 1982916797
Provider Name (Legal Business Name): LOUIS PATRICK MCGUIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/21/2022
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MARTIN LUTHER KING DR
MANKATO MN
56001-6460
US

IV. Provider business mailing address

20795 KEOKUK AVE
LAKEVILLE MN
55044-6004
US

V. Phone/Fax

Practice location:
  • Phone: 507-385-6500
  • Fax:
Mailing address:
  • Phone: 952-428-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56378
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: