1205857844 NPI number — ROBERT M MCGUCKEN MD

Table of content: ROBERT M MCGUCKEN MD (NPI 1205857844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205857844 NPI number — ROBERT M MCGUCKEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGUCKEN
Provider First Name:
ROBERT
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205857844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2727 PLAZA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUSAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54401-4129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-847-3000
Provider Business Mailing Address Fax Number:
715-847-3329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54401-4129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-847-3000
Provider Business Practice Location Address Fax Number:
715-847-3329
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  33399020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MCGUCKEN . This is a "WPS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 32126600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 391330887 . This is a "ASSOCIATES FOR HEALTHCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 41799 . This is a "SECURITY HEALTH PLAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 050059647 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 32126600 . This is a "MANAGED HEALTH CARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 391330887 . This is a "HEALTH EOS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 41799 . This is a "SECURITY HEALTH MEDICAID" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 001239110 . This is a "MEDICARE - HUMANA GOLD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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