Healthcare Provider Details

I. General information

NPI: 1700397775
Provider Name (Legal Business Name): MAGUIRE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 ALEXANDRIA WAY
MACEDONIA OH
44056-1998
US

IV. Provider business mailing address

2055 ALEXANDRIA WAY
MACEDONIA OH
44056-1998
US

V. Phone/Fax

Practice location:
  • Phone: 330-468-3312
  • Fax: 330-468-0602
Mailing address:
  • Phone: 330-468-3312
  • Fax: 330-468-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: THOMAS M MAGUIRE
Title or Position: TAX ID OWNER
Credential: DO
Phone: 330-468-3312