Provider Demographics
NPI:1528048048
Name:MCGINNIS, MICHAEL BERNARD (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BERNARD
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 GUNWALE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-7990
Mailing Address - Country:US
Mailing Address - Phone:850-207-8834
Mailing Address - Fax:
Practice Address - Street 1:340 HULSE ROAD
Practice Address - Street 2:CODE 33
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-1092
Practice Address - Country:US
Practice Address - Phone:850-452-3154
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine