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General NPI Number Information
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NPI Number | 1164931960
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Entity Type | Individual
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Provider Name | MICHAEL MARTIN MCGUIRE PA-C, ATC
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Gender | Male
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 670 PIERCE BLVD STE 200
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City | O FALLON
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State | IL
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Zip | 62269-2579
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Country | US
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Telephone | 618-206-2094
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Fax |
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Provider Business Mailing Address
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Address Line | 670 PIERCE BLVD
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City | O FALLON
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State | IL
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Zip | 62269-2579
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Country | US
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Telephone | 618-206-2094
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Fax | 618-607-5127
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 003657-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.011631
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License Number State | IL
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