Provider Demographics
NPI:1548479991
Name:MCNEELY, MAUREEN (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:710 CHIPPEWA SQ
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4821
Mailing Address - Country:US
Mailing Address - Phone:906-226-2569
Mailing Address - Fax:906-226-3225
Practice Address - Street 1:710 CHIPPEWA SQ
Practice Address - Street 2:SUITE 103
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4821
Practice Address - Country:US
Practice Address - Phone:906-226-2569
Practice Address - Fax:906-226-3225
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301100628207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548479991Medicaid
MIE26006012Medicare UPIN