Healthcare Provider Details

I. General information

NPI: 1396920823
Provider Name (Legal Business Name): DR MICHAEL MCGUINESS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 N PRESTON RD STE 60
PROSPER TX
75078-9890
US

IV. Provider business mailing address

PO BOX 679191
DALLAS TX
75267-9191
US

V. Phone/Fax

Practice location:
  • Phone: 972-316-4555
  • Fax: 469-481-2373
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MCGUINESS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-615-1900