Basic Information
| Provider Information | |||||||||
| NPI: | 1588744270 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACDONALD | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31157 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480730996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483360123 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14800 FARMINGTON RD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481545461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342617401 | ||||||||
| FaxNumber: | 7342617417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 4301076083 | MI | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 0425310001 | 01 | MI | DMERC-OAKLAND OFFICE | OTHER | 3400827488 | 01 | MI | BLUE CROSS BLUE SHEILD | OTHER | 382032989 | 01 | MI | COMMERCIAL | OTHER | 0425310004 | 01 | MI | DMERC-WARREN OFFICE | OTHER | 105177953 | 05 | MI | MEDICAID | MM076083 | 01 | MI | BLUE CROSS BLUE SHEILD | OTHER | 3400827488 | 01 | MI | BLUE CARE NETWORK | OTHER | 0425310002 | 01 | MI | DMERC-LIVONIA OFFICE | OTHER | 0425310003 | 01 | MI | DMERC-MACOMB OFFICE | OTHER |