Provider Demographics
NPI:1063914802
Name:MCGILLIGAN MD, INC.
Entity type:Organization
Organization Name:MCGILLIGAN MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-715-5044
Mailing Address - Street 1:7529 STATE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-6410
Mailing Address - Country:US
Mailing Address - Phone:513-715-5044
Mailing Address - Fax:513-725-2229
Practice Address - Street 1:7529 STATE RD STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-6410
Practice Address - Country:US
Practice Address - Phone:513-715-5044
Practice Address - Fax:513-725-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care