Provider Demographics
NPI:1750347225
Name:MCCUNE, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:MCCUNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J.
Other - Middle Name:MICHAEL
Other - Last Name:MCCUNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:405 E. MAIN
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1928
Mailing Address - Country:US
Mailing Address - Phone:641-753-2752
Mailing Address - Fax:641-753-6450
Practice Address - Street 1:405 E. MAIN
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1928
Practice Address - Country:US
Practice Address - Phone:641-753-2752
Practice Address - Fax:641-753-6450
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13116208600000X
IA25059208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100193350AMedicaid
OK100193350AMedicaid