Provider Demographics
NPI:1770527228
Name:MCGILL, BRIDGET A (DO)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:A
Last Name:MCGILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:DELLWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55110-1432
Mailing Address - Country:US
Mailing Address - Phone:651-407-0846
Mailing Address - Fax:
Practice Address - Street 1:34 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:DELLWOOD
Practice Address - State:MN
Practice Address - Zip Code:55110-1432
Practice Address - Country:US
Practice Address - Phone:651-407-0846
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF43843Medicare UPIN