MEDICARE: COLLEEN ALANE MCGUIRE M.D.

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	2084P0800X	Psychiatry Physician	125059605	IL

General Provider Information

NPI Number	:	1487940144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN ALANE MCGUIRE M.D.

Provider Business Mailing Address
First Line	:	558 W ARMITAGE AVE
Second Line	:	UNIT A-2
City	:	CHICAGO
State	:	IL
Zip	:	60614-4550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	558 W ARMITAGE AVE
Second Line	:	UNIT A-2
City	:	CHICAGO
State	:	IL
Zip	:	60614-4550
Country	:	US
Telephone Number	:	574-870-1377
Fax Number	:

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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