Provider Demographics
NPI:1588618094
Name:MCGUIRE MEDICAL SC
Entity Type:Organization
Organization Name:MCGUIRE MEDICAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-731-6879
Mailing Address - Street 1:2315 E 93RD ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3910
Mailing Address - Country:US
Mailing Address - Phone:773-731-6879
Mailing Address - Fax:773-731-7791
Practice Address - Street 1:2315 E 93RD ST
Practice Address - Street 2:SUITE 224
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3910
Practice Address - Country:US
Practice Address - Phone:773-731-6879
Practice Address - Fax:773-791-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209524Medicare PIN