Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 5027-015 | WI |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 21002690 | IL |
NPI | 1114185204 |
---|---|
Provider Name | Dr. Shea M Mccue |
First Address | Belleville, WI 53508-8800 |
Second Address | Belleville, WI 53508-8800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 02/05/2018 |