Provider Demographics
NPI:1174575450
Name:MCGUIRE, NANCY M (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22301 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2619
Mailing Address - Country:US
Mailing Address - Phone:586-443-5588
Mailing Address - Fax:586-443-5538
Practice Address - Street 1:22301 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2619
Practice Address - Country:US
Practice Address - Phone:586-443-5588
Practice Address - Fax:586-443-5538
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228651207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1174575450Medicaid
NM02X28010Medicare ID - Type Unspecified
MI0N40170Medicare PIN
MI1174575450Medicaid