Individual
KELLY WAYNE MCGUIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6301 UNIVERSITY COMMONS, SUITE 310, SOUTH BEND, IN 46635-1571
(574) 232-1471
(574) 239-8511
Mailing address
6301 UNIVERSITY COMMONS, STE 230, SOUTH BEND, IN 46635-1571
(574) 251-2100
(574) 251-2151
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01060309
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000621003
BCBS
IN
05
—
200523290
—
IN
Enumeration date
05/23/2006
Last updated
09/06/2011
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