Provider Demographics
NPI:1730858531
Name:MAKEDONSKY, ASHLEY B
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:B
Last Name:MAKEDONSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 FARNSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-8717
Mailing Address - Country:US
Mailing Address - Phone:810-837-1844
Mailing Address - Fax:
Practice Address - Street 1:1350 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6106
Practice Address - Country:US
Practice Address - Phone:248-969-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator