Individual
MICHAEL MARTIN MCGUIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
670 PIERCE BLVD STE 200, O FALLON, IL 62269-2579
(618) 206-2094
Mailing address
670 PIERCE BLVD, O FALLON, IL 62269-2579
(618) 206-2094
(618) 607-5127
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
003657-1
NY
2255A2300X
Athletic Trainer
—
IN
363A00000X
Physician Assistant
Primary
085.011631
IL
Other
Enumeration date
09/25/2017
Last updated
12/11/2025
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