Provider Demographics
NPI:1861578866
Name:MACDERMID, NORMAN GILBERT (DO)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:GILBERT
Last Name:MACDERMID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2939
Mailing Address - Country:US
Mailing Address - Phone:734-699-3477
Mailing Address - Fax:
Practice Address - Street 1:142 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2939
Practice Address - Country:US
Practice Address - Phone:734-699-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF27715Medicare UPIN
5823052Medicare ID - Type Unspecified