Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 22619 | MN |
NPI | 1003992116 |
---|---|
Provider Name | Dr. Philip Mcglave |
First Address | Minneapolis, MN 55455 |
Second Address | Minneapolis, MN 55455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 26/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0968784 | (05) | IA |
100801 | UCARE (01) | |
1009236 | PREFERRED ONE (01) | |
2T164MC | BLUE CROSS BLUE SHIELD (01) | |
30-00025 | MEDICA PRIMARY (01) | |
30-07837 | MEDICA CHOICE (01) | |
494768100 | (05) | MN |
765734 | ARAZ (01) | |
B58583 | (02) | |
HP22086 | HEALTH PARTNERS (01) |