Provider Demographics
NPI:1205857844
Name:MCGUCKEN, ROBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:MCGUCKEN
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 1:2727 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4129
Mailing Address - Country:US
Mailing Address - Phone:715-847-3000
Mailing Address - Fax:715-847-3329
Practice Address - Street 1:2727 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4129
Practice Address - Country:US
Practice Address - Phone:715-847-3000
Practice Address - Fax:715-847-3329
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33399020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIMCGUCKENOtherWPS
WI32126600Medicaid
WI391330887OtherASSOCIATES FOR HEALTHCARE
WV41799OtherSECURITY HEALTH PLAN
WI050059647OtherMEDICARE RAILROAD
WI32126600OtherMANAGED HEALTH CARE
WI391330887OtherHEALTH EOS
WI41799OtherSECURITY HEALTH MEDICAID
WI001239110OtherMEDICARE - HUMANA GOLD
WV41799OtherSECURITY HEALTH PLAN
WI41799OtherSECURITY HEALTH MEDICAID
WIG04140Medicare UPIN