Provider Demographics
NPI:1013210368
Name:MAGUIRE, VALERIE CECELIA (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:CECELIA
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10607 RANDOLPH ST
Mailing Address - Street 2:STE A
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7505
Mailing Address - Country:US
Mailing Address - Phone:219-663-4007
Mailing Address - Fax:219-663-4198
Practice Address - Street 1:10607 RANDOLPH ST
Practice Address - Street 2:STE A
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7505
Practice Address - Country:US
Practice Address - Phone:219-663-4007
Practice Address - Fax:219-663-4198
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040593A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F44858Medicare UPIN
INF44858Medicare UPIN