Provider Demographics
NPI:1871467381
Name:MCCREARY, MICHAEL SR
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCCREARY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N79W17879 TAMARACK SPRINGS CIR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4097
Mailing Address - Country:US
Mailing Address - Phone:608-335-5242
Mailing Address - Fax:
Practice Address - Street 1:N79W17879 TAMARACK SPRINGS CIR UNIT 6
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4097
Practice Address - Country:US
Practice Address - Phone:608-335-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies