Provider Demographics
NPI:1386727568
Name:TOMAS A MACATANGAY
Entity type:Organization
Organization Name:TOMAS A MACATANGAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACATANGAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-739-0505
Mailing Address - Street 1:45100 STERRITT ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5843
Mailing Address - Country:US
Mailing Address - Phone:586-739-0505
Mailing Address - Fax:586-739-0012
Practice Address - Street 1:45100 STERRITT ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5843
Practice Address - Country:US
Practice Address - Phone:586-739-0505
Practice Address - Fax:586-739-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1038657Medicaid
MI1038657Medicaid