Provider Demographics
NPI:1750640520
Name:MICHAEL F. MCGUIRE, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL F. MCGUIRE, MD, A PROFESSIONAL CORPORATION
Other - Org Name:MICHAEL MCGUIRE, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-315-0121
Mailing Address - Street 1:1301 20TH ST.
Mailing Address - Street 2:SUITE 460
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2090
Mailing Address - Country:US
Mailing Address - Phone:310-315-0121
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST.
Practice Address - Street 2:SUITE 460
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2090
Practice Address - Country:US
Practice Address - Phone:310-315-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25248Medicare UPIN