MEDICARE: MICHAEL H MCCARTY PA-C

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	363A00000X	Physician Assistant	9452	MN

General Provider Information

NPI Number	:	1649270273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL H MCCARTY PA-C

Provider Business Mailing Address
First Line	:	435 S GROVE ST
Second Line	:	STE 1
City	:	BLUE EARTH
State	:	MN
Zip	:	56013-2604
Country	:	US
Telephone Number	:	507-526-7388
Fax Number	:	507-526-2467

Provider Business Practice Location Address
First Line	:	435 S GROVE ST
Second Line	:	STE 1
City	:	BLUE EARTH
State	:	MN
Zip	:	56013-2604
Country	:	US
Telephone Number	:	507-526-7388
Fax Number	:	507-526-2467

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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