Provider Demographics
NPI:1285793711
Name:MCNALLY, MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BARIBEAU DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3249
Mailing Address - Country:US
Mailing Address - Phone:207-729-6686
Mailing Address - Fax:207-729-6687
Practice Address - Street 1:85 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3249
Practice Address - Country:US
Practice Address - Phone:207-729-6686
Practice Address - Fax:207-729-6687
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD164213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME039324OtherANTHEM
MEM1310OtherCIGNA
ME2492941OtherAETNA
ME133310099Medicaid
MEM1310OtherCIGNA
ME133310099Medicaid
ME2492941OtherAETNA