Basic Information
| Provider Information | |||||||||
| NPI: | 1922083724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACARANAS | ||||||||
| FirstName: | DOMINIC | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11307 N VIA MILANO WAY | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937308840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594493240 | ||||||||
| FaxNumber: | 5594493240 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 MALL DR | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932305786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595371670 | ||||||||
| FaxNumber: | 5595371678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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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 | 207R00000X | 036-104602 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | C54002 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | C54002 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 0361046022 | 05 | IL | MEDICAID | 05532012 | 01 | IL | BCBS OF ILLINOIS | OTHER |