Provider Demographics
NPI:1225197601
Name:MCGRATH, MIC
Entity Type:Individual
Prefix:
First Name:MIC
Middle Name:
Last Name:MCGRATH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 FLAT ROCK DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-5864
Mailing Address - Country:US
Mailing Address - Phone:951-509-0246
Mailing Address - Fax:951-352-4843
Practice Address - Street 1:4130 FLAT ROCK DR
Practice Address - Street 2:SUITE 150
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-5864
Practice Address - Country:US
Practice Address - Phone:951-509-0246
Practice Address - Fax:951-352-4843
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4580800001Medicare ID - Type Unspecified