Provider Demographics
NPI:1588744270
Name:MACDONALD, MICHAEL FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:31157 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0996
Mailing Address - Country:US
Mailing Address - Phone:248-336-0123
Mailing Address - Fax:
Practice Address - Street 1:14800 FARMINGTON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5461
Practice Address - Country:US
Practice Address - Phone:734-261-7401
Practice Address - Fax:734-261-7417
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076083208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0425310001OtherDMERC-OAKLAND OFFICE
MI3400827488OtherBLUE CROSS BLUE SHEILD
MI382032989OtherCOMMERCIAL
MI0425310004OtherDMERC-WARREN OFFICE
MI105177953Medicaid
MIMM076083OtherBLUE CROSS BLUE SHEILD
MI3400827488OtherBLUE CARE NETWORK
MI0425310002OtherDMERC-LIVONIA OFFICE
MI0425310003OtherDMERC-MACOMB OFFICE
MI105177953Medicaid
MI382032989OtherCOMMERCIAL