Provider Demographics
NPI:1548361249
Name:JOHNS S. MAC DONALD, MD PC
Entity type:Organization
Organization Name:JOHNS S. MAC DONALD, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAC DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-224-0646
Mailing Address - Street 1:110 W HIGHAM ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1559
Mailing Address - Country:US
Mailing Address - Phone:989-224-0646
Mailing Address - Fax:989-224-0929
Practice Address - Street 1:110 W HIGHAM ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1559
Practice Address - Country:US
Practice Address - Phone:989-224-0646
Practice Address - Fax:989-224-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10 2116963Medicaid
MIP50220001Medicare PIN
B47532Medicare UPIN