Basic Information
Provider Information | |||||||||
NPI: | 1386613818 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCGUIRE | ||||||||
FirstName: | WARREN | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1580 BEAM AVE | ||||||||
Address2: |   | ||||||||
City: | MAPLEWOOD | ||||||||
State: | MN | ||||||||
PostalCode: | 551091127 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6517797978 | ||||||||
FaxNumber: | 6517797656 | ||||||||
Practice Location | |||||||||
Address1: | 1580 BEAM AVE | ||||||||
Address2: |   | ||||||||
City: | MAPLEWOOD | ||||||||
State: | MN | ||||||||
PostalCode: | 551091127 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6517797978 | ||||||||
FaxNumber: | 6517797656 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/16/2006 | ||||||||
LastUpdateDate: | 10/13/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 35757 | MN | Y |   | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
ID | Type | State | Issuer | Description | 109109 | 01 | MN | UCARE MN | OTHER | 2428639 | 01 | MN | MEDICA | OTHER | 32478900 | 05 | WI |   | MEDICAID | 3T999MC | 01 | MN | BLUE CROSS BLUE SHIELD MN | OTHER | 1012219 | 01 | MN | PREFERREDONE | OTHER | 768258 | 01 | MN | AMERICA'S PPO | OTHER | 603765800 | 05 | MN |   | MEDICAID | HP22131 | 01 | MN | HEALTHPARTNERS | OTHER |