Provider Demographics
NPI:1821033937
Name:MCCUE, JONATHAN DEAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DEAN
Last Name:MCCUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 CAMPUS DR STE 335
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2679
Mailing Address - Country:US
Mailing Address - Phone:952-830-0089
Mailing Address - Fax:
Practice Address - Street 1:2805 CAMPUS DR STE 335
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2679
Practice Address - Country:US
Practice Address - Phone:952-830-0089
Practice Address - Fax:952-562-5949
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47237208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNI26903Medicare UPIN