Provider Demographics
NPI:1982924593
Name:MCCOURT, MICHAEL JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MCCOURT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:EUGENE
Other - Middle Name:FOOT
Other - Last Name:AND ANKLE HEALTH CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1680 CHAMBERS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3655
Mailing Address - Country:US
Mailing Address - Phone:541-683-3351
Mailing Address - Fax:541-683-6440
Practice Address - Street 1:1680 CHAMBERS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3655
Practice Address - Country:US
Practice Address - Phone:541-683-3351
Practice Address - Fax:541-683-6440
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL1768213ES0103X
ORDP152629213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery