Provider Demographics
NPI:1871528646
Name:MCMAHON, SHAWN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PATRICK
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1300
Mailing Address - Country:US
Mailing Address - Phone:218-834-7727
Mailing Address - Fax:218-834-7727
Practice Address - Street 1:325 11TH AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1300
Practice Address - Country:US
Practice Address - Phone:218-834-7727
Practice Address - Fax:218-834-7727
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN336702900Medicaid
MN080015185Medicare PIN
MN080117249Medicare PIN
MN089005438Medicare PIN
MN080015184Medicare PIN
MNE56344Medicare UPIN