Provider Demographics
NPI:1750422531
Name:MCGINNIS, JOHN RAYMOND (MT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RAYMOND
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E 131ST ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3876
Mailing Address - Country:US
Mailing Address - Phone:952-890-6155
Mailing Address - Fax:
Practice Address - Street 1:20176 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6855
Practice Address - Country:US
Practice Address - Phone:612-839-4995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other