Provider Demographics
NPI:1063439693
Name:MCCARVILLE, MAUREEN A (DO, FACEP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:MCCARVILLE
Suffix:
Gender:F
Credentials:DO, FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 REMIT DR
Mailing Address - Street 2:LOCKBOX 6900
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6900
Mailing Address - Country:US
Mailing Address - Phone:866-916-5259
Mailing Address - Fax:
Practice Address - Street 1:3401 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1300
Practice Address - Country:US
Practice Address - Phone:906-786-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011528207P00000X
IA02169207P00000X
IL36073922207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00344632OtherRAILROAD MEDICARE
MI1063439693Medicaid
C42723Medicare UPIN
MIP29950007Medicare PIN