Provider Demographics
NPI:1386877124
Name:PERCY H, MCDONALD, M.D., P.C.
Entity type:Organization
Organization Name:PERCY H, MCDONALD, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PERCY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-984-4400
Mailing Address - Street 1:1107 STONE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3569
Mailing Address - Country:US
Mailing Address - Phone:810-984-4400
Mailing Address - Fax:810-984-1264
Practice Address - Street 1:1107 STONE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3569
Practice Address - Country:US
Practice Address - Phone:810-984-4400
Practice Address - Fax:810-984-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB44352Medicare UPIN
MI07409477042Medicare PIN