Provider Demographics
NPI:1407841653
Name:MCCORMICK, MICHAEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:J
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:125 SCHOOL ST
Mailing Address - Street 2:PO BOX F
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-8702
Mailing Address - Country:US
Mailing Address - Phone:515-989-3221
Mailing Address - Fax:515-989-4518
Practice Address - Street 1:125 SCHOOL ST
Practice Address - Street 2:PO BOX F
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-8702
Practice Address - Country:US
Practice Address - Phone:515-989-3221
Practice Address - Fax:515-989-4518
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0149898Medicaid
420870851OtherCOMMERCIAL
01006OtherSECURECARE
0100026OtherCOVPC
14955OtherHCP
IA14989OtherWELLMARK
IA119600OtherCOVENTRY
IA0101OtherHERITAGE
119600OtherCOVOP
D46457Medicare UPIN
01006OtherSECURECARE