Provider Demographics
NPI:1801841358
Name:MCGINNIS, MICHAEL CLIFTON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CLIFTON
Last Name:MCGINNIS
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 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:911 SUNSET DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5606
Practice Address - Country:US
Practice Address - Phone:831-637-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141451207ZP0102X
NY255317207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144647OtherUNITED HEALTHCARE
NJ60015389OtherHORIZON NJ HEALTH
OK100208290AMedicaid
NY250774730N01OtherHIP OF NY
302894OtherAVMED,INC
NJ5001628OtherGHI
NJ2359696000OtherAMERIHEALTH
NJP00208899OtherRR MEDICARE
P3431936OtherOXFORD
100745580BOtherSOONERCARE
4093337OtherAMERICAN TRAVELERS ASSUR.
NJ0052167Medicaid
OK1590753OtherGHI
NY2738769Medicaid
NJ2K7528OtherHEALTHNET
NJ39305OtherUHP OF NJ
NJ91001516800OtherAMERICHOICE
NY250774730N01OtherHIP OF NY
NY2738769Medicaid
4093337OtherAMERICAN TRAVELERS ASSUR.