Basic Information
| Provider Information | |||||||||
| NPI: | 1619934304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCNEAR | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 MAPLE SUMMIT RD | ||||||||
| Address2: | |||||||||
| City: | JERSEYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620522000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184987518 | ||||||||
| FaxNumber: | 6184983052 | ||||||||
| Practice Location | |||||||||
| Address1: | 523 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620161251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2179423326 | ||||||||
| FaxNumber: | 2179429833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036099944 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 036099944 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036099944 | 05 | IL | MEDICAID | P01534027 | 01 | IL | RAILROAD MEDICARE | OTHER |