Provider Demographics
NPI:1760489702
Name:MACDONALD, EUGENE M (DPM)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:M
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 523882
Mailing Address - Street 2:C/O THE MAILBOX #10649
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33152-7604
Mailing Address - Country:US
Mailing Address - Phone:317-827-2987
Mailing Address - Fax:317-219-0879
Practice Address - Street 1:PO BOX 523882
Practice Address - Street 2:C/O THE MAILBOX #10649
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33152-7604
Practice Address - Country:US
Practice Address - Phone:317-827-2987
Practice Address - Fax:317-219-0879
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000615A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100123970Medicaid
IN192530JMedicare PIN
IN100123970Medicaid
IN480034542Medicare PIN
IN4685310001Medicare NSC