Provider Demographics
NPI:1235116963
Name:MCGAHAN, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:MCGAHAN
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 1:2717 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7271
Mailing Address - Country:US
Mailing Address - Phone:308-381-6656
Mailing Address - Fax:308-381-6680
Practice Address - Street 1:2620 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4205
Practice Address - Country:US
Practice Address - Phone:308-398-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17445207P00000X
KS047443207Q00000X
KS0424377207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1235116963Medicaid
NE47037877912Medicaid
KS1235116963OtherBLUE SHIELD
KS20579960DMedicaid
KS200579960BMedicaid
NE03470OtherNE BLUE CROSS BLUE SHIELD
KS20579960DMedicaid
NE1235116963Medicaid
KS200579960BMedicaid
KSKA1398028Medicare PIN