Provider Demographics
NPI:1447536271
Name:MAGUIRE, MICHAEL T (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:MAGUIRE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14454 HARRISON PKWY
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-5249
Mailing Address - Country:US
Mailing Address - Phone:765-606-0108
Mailing Address - Fax:
Practice Address - Street 1:9240 N MERIDIAN ST
Practice Address - Street 2:SUITE 320
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1880
Practice Address - Country:US
Practice Address - Phone:317-844-7489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042539A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical