Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 5570-12 | WI |
NPI | 1518568302 |
---|---|
Provider Name | Dr. Michael James Mcginnis |
First Address | Winneconne, WI 54986-9705 |
Second Address | Winneconne, WI 54986-9705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2020 |
Last Update Date | 06/11/2020 |