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General NPI Number Information
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NPI Number | 1083835052
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Entity Type | Organization
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Legal Business Name | MICHAEL MCGUIRE, MD, LLC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9711 SKOKIE BLVD SUITE H
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City | SKOKIE
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State | IL
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Zip | 60077-1384
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Country | US
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Telephone | 847-676-2400
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Fax | 847-676-2485
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Provider Business Mailing Address
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Address Line | 9711 SKOKIE BLVD SUITE H
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City | SKOKIE
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State | IL
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Zip | 60077-1384
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Country | US
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Telephone | 847-676-2400
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Fax | 847-676-2485
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL SHANE MCGUIRE
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Credential | MD
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Telephone | 847-676-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | IL
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