Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2736 | ME |
NPI | 1386618106 |
---|---|
Provider Name | Dr. John Leo Mcginley |
First Address | Great Lakes, IL 60088-5259 |
Second Address | Great Lakes, IL 60088-5259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 29/10/2007 |