Healthcare Provider Details

I. General information

NPI: 1568532653
Provider Name (Legal Business Name): JAMES M. MCGREEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 BEAM AVE SUITE 302
MAPLEWOOD MN
55109-1163
US

IV. Provider business mailing address

1655 BEAM AVE SUITE 302
MAPLEWOOD MN
55109-1163
US

V. Phone/Fax

Practice location:
  • Phone: 651-227-6351
  • Fax: 651-227-1134
Mailing address:
  • Phone: 651-227-6351
  • Fax: 651-227-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number50064
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: