Individual provider Active NPI

John E McGillicuddy, MD

  • Neurological Surgery Physician
  • Ann Arbor, MI
National Provider Identifier
1366549628
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
4301032814 Issued in MI
Practice address
1500 East Medical Center Dr
2ND Floor Taubman Ctr Recp G
Ann Arbor, MI 48109-5338
Phone
(734) 936-7010
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 4301032814 MI Primary

Addresses

Primary practice location

1500 East Medical Center Dr
2ND Floor Taubman Ctr Recp G
Ann Arbor, MI 48109-5338

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 1

IdentifierTypeStateIssuer
1275633MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316044800000",
    "number": "1366549628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DR",
            "address_2": "2ND FLOOR TAUBMAN CTR RECP G",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095338",
            "telephone_number": "734-936-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGILLICUDDY",
        "first_name": "JOHN",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MI",
            "license": "4301032814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275633",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.