Provider Demographics
NPI:1053503466
Name:MCGUIRK, DOUGLAS JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JUSTIN
Last Name:MCGUIRK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3005
Mailing Address - Fax:812-242-3054
Practice Address - Street 1:1725 N 5TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4010
Practice Address - Country:US
Practice Address - Phone:812-242-3005
Practice Address - Fax:812-242-3054
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN498072086S0105X
IN01065621A2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00866722OtherRAILROAD MEDICARE
INP00718154OtherRAILROAD MEDICARE
INP00718154OtherRAILROAD MEDICARE
INP00866722OtherRAILROAD MEDICARE
IN265130B9Medicare PIN