Provider Demographics
NPI:1134114200
Name:MCGUIRE, JOHN KELLOGG (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KELLOGG
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3123 SHORE DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4287
Mailing Address - Country:US
Mailing Address - Phone:715-732-2299
Mailing Address - Fax:715-732-2419
Practice Address - Street 1:3123 SHORE DR
Practice Address - Street 2:SUITE #102
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4287
Practice Address - Country:US
Practice Address - Phone:715-732-2299
Practice Address - Fax:715-732-2419
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI25995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI110047469OtherMEDICARE RAILROAD
WI30682900Medicaid
WI110047469OtherMEDICARE RAILROAD
WI30682900Medicaid
WIB54951Medicare UPIN