Basic Information
| Provider Information | |||||||||
| NPI: | 1205857844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGUCKEN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 E DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549354560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209268340 | ||||||||
| FaxNumber: | 9209268370 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 E DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549354560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209268340 | ||||||||
| FaxNumber: | 9209268370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 33399020 | WI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 32126600 | 01 | WI | MANAGED HEALTH CARE | OTHER | 391330887 | 01 | WI | ASSOCIATES FOR HEALTHCARE | OTHER | 32126600 | 05 | WI | MEDICAID | MCGUCKEN | 01 | WI | WPS | OTHER | 001239110 | 01 | WI | MEDICARE - HUMANA GOLD | OTHER | 050059647 | 01 | WI | MEDICARE RAILROAD | OTHER | 391330887 | 01 | WI | HEALTH EOS | OTHER | 41799 | 01 | WV | SECURITY HEALTH PLAN | OTHER | 41799 | 01 | WI | SECURITY HEALTH MEDICAID | OTHER |