Provider Demographics
NPI:1801860440
Name:MCNAMARA, MICHAEL R (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:829 N CENTER AVE
Mailing Address - Street 2:SUITE 298
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1595
Mailing Address - Country:US
Mailing Address - Phone:989-731-7708
Mailing Address - Fax:989-731-7929
Practice Address - Street 1:3040 BOURN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:MI
Practice Address - Zip Code:49756-8134
Practice Address - Country:US
Practice Address - Phone:989-786-4877
Practice Address - Fax:989-786-2187
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI1801860440208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F96004OtherGROUP MEDICARE ID NUMBER
MI2838664Medicaid
MIE78171Medicare UPIN
MI5604992Medicare PIN