Basic Information
| Provider Information | |||||||||
| NPI: | 1366441982 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGUIRE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 551 N HILLSIDE ST | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672144923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166851367 | ||||||||
| FaxNumber: | 3166821436 | ||||||||
| Practice Location | |||||||||
| Address1: | 551 N HILLSIDE ST | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672144923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166851367 | ||||||||
| FaxNumber: | 3166821436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 01/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 0422687 | KS | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.