Provider Demographics
NPI:1124186721
Name:MAGUIRE, MICHAEL F (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:MAGUIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 THEDA CLARK MEDICAL PLZ
Mailing Address - Street 2:SUITE 480
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2721
Mailing Address - Country:US
Mailing Address - Phone:920-729-0608
Mailing Address - Fax:920-729-2902
Practice Address - Street 1:2500 E CAPITOL DRIVE
Practice Address - Street 2:SUITE 1700
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911
Practice Address - Country:US
Practice Address - Phone:920-734-9600
Practice Address - Fax:920-734-4773
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI36569207RC0200X, 207RP1001X, 207RS0012X
WI36569-020207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32116400Medicaid
WI454450003Medicare ID - Type Unspecified
WI32116400Medicaid
WIG05905Medicare UPIN