1588744270 NPI number — DR. MICHAEL FRANCIS MACDONALD M.D.

Table of content: DR. MICHAEL FRANCIS MACDONALD M.D. (NPI 1588744270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588744270 NPI number — DR. MICHAEL FRANCIS MACDONALD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACDONALD
Provider First Name:
MICHAEL
Provider Middle Name:
FRANCIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588744270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31157 WOODWARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROYAL OAK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48073-0996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-336-0123
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14800 FARMINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48154-5461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-261-7401
Provider Business Practice Location Address Fax Number:
734-261-7417
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  4301076083 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0425310001 . This is a "DMERC-OAKLAND OFFICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3400827488 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382032989 . This is a "COMMERCIAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0425310004 . This is a "DMERC-WARREN OFFICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 105177953 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: MM076083 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3400827488 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0425310002 . This is a "DMERC-LIVONIA OFFICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0425310003 . This is a "DMERC-MACOMB OFFICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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