Provider Demographics
NPI:1083835052
Name:MICHAEL MCGUIRE, MD, LLC
Entity Type:Organization
Organization Name:MICHAEL MCGUIRE, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-676-2400
Mailing Address - Street 1:9711 SKOKIE BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1384
Mailing Address - Country:US
Mailing Address - Phone:847-676-2400
Mailing Address - Fax:847-676-2485
Practice Address - Street 1:9711 SKOKIE BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1384
Practice Address - Country:US
Practice Address - Phone:847-676-2400
Practice Address - Fax:847-676-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622253OtherBLUE CROSS BLUE SHIELD
ILG72931Medicare UPIN
IL01622253OtherBLUE CROSS BLUE SHIELD