Provider Demographics
NPI:1689640963
Name:MCGONIGAL, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:MCGONIGAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8362 TAMARACK VILLAGE
Mailing Address - Street 2:STE 119-280
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3392
Mailing Address - Country:US
Mailing Address - Phone:952-883-5790
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:8362 TAMARACK VILLAGE
Practice Address - Street 2:STE 119-280
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55125-3392
Practice Address - Country:US
Practice Address - Phone:651-334-9745
Practice Address - Fax:888-978-4792
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-10-24
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Provider Licenses
StateLicense IDTaxonomies
MN36628208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F62913Medicare UPIN