Provider Demographics
NPI:1760890024
Name:MCGUIRE INTEGRATED MEDICAL GROUP PC
Entity Type:Organization
Organization Name:MCGUIRE INTEGRATED MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-997-5000
Mailing Address - Street 1:2103 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1163
Mailing Address - Country:US
Mailing Address - Phone:618-997-5000
Mailing Address - Fax:618-997-8658
Practice Address - Street 1:2103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1163
Practice Address - Country:US
Practice Address - Phone:618-997-5000
Practice Address - Fax:618-997-8658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088228208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty