Basic Information
| Provider Information | |||||||||
| NPI: | 1588604193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGILL | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | BERNADETTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133900 | ||||||||
| FaxNumber: | 5179133901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133900 | ||||||||
| FaxNumber: | 5179133901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 10/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301065738 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1001915 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER | 200000002373 | 01 | MI | PHP | OTHER | 1103302861 | 01 | MI | BCBS/BCN | OTHER | 200000002373 | 01 | MI | PHP FAMILYCARE | OTHER | 0M21440005 | 01 | MI | MEDICARE ADVANTAGE | OTHER | 4083610 | 05 | MI | MEDICAID | 1001915 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 4848098 | 05 | MI | MEDICAID | 1001915 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 110169067 | 01 | MI | RAILROAD MEDICARE | OTHER | 5248555 | 01 | MI | AETNA | OTHER |