Provider Demographics
NPI:1407955800
Name:MCGLEW, MARY JOSEPHINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOSEPHINE
Last Name:MCGLEW
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1215 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1811
Mailing Address - Country:US
Mailing Address - Phone:517-364-2117
Mailing Address - Fax:517-364-3994
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-2117
Practice Address - Fax:517-364-3994
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010538502080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2589747Medicaid
MI0330570Medicare ID - Type Unspecified
MI2589747Medicaid