MEDICARE: DR. MICHAEL J MCCORMICK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01683	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	420870851	OTHER		COMMERCIAL
3	01006	OTHER		SECURECARE
4	0100026	OTHER		COVPC
5	14955	OTHER		HCP
6	14989	OTHER	IA	WELLMARK
7	119600	OTHER	IA	COVENTRY
8	IA0101	OTHER		HERITAGE
9	119600	OTHER		COVOP

General Provider Information

NPI Number	:	1407841653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J MCCORMICK DO

Provider Business Mailing Address
First Line	:	125 SCHOOL ST
Second Line	:	PO BOX F
City	:	CARLISLE
State	:	IA
Zip	:	50047-8702
Country	:	US
Telephone Number	:	515-989-3221
Fax Number	:	515-989-4518

Provider Business Practice Location Address
First Line	:	125 SCHOOL ST
Second Line	:	PO BOX F
City	:	CARLISLE
State	:	IA
Zip	:	50047-8702
Country	:	US
Telephone Number	:	515-989-3221
Fax Number	:	515-989-4518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	01/07/2010

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Directions to “ DR. MICHAEL J MCCORMICK DO” Practice Location

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