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Individual

MICHAEL R MCENTIRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-8526

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
M-12480
ID
207L00000X
Anesthesiology Physician
R71475
AZ
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
M-12480
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
ENROLLED
MN
01
P01021805
RAILROAD MEDICARE
MN
Enumeration date
02/23/2010
Last updated
02/09/2016
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