Provider Demographics
NPI:1164931960
Name:MCGUIRE, MICHAEL MARTIN (MS, LAT, ATC, PA-S)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MARTIN
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:MS, LAT, ATC, PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9443 GRANDVIEW CT
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1591
Mailing Address - Country:US
Mailing Address - Phone:317-501-6249
Mailing Address - Fax:
Practice Address - Street 1:1050 WISHARD BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2872
Practice Address - Country:US
Practice Address - Phone:317-274-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003657-12255A2300X
IN2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer