Provider Demographics
NPI:1699789396
Name:MCDONALD, MARY F (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 JACKSON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-8144
Mailing Address - Country:US
Mailing Address - Phone:920-426-2211
Mailing Address - Fax:920-426-2231
Practice Address - Street 1:2700 W 9TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7247
Practice Address - Country:US
Practice Address - Phone:920-223-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28027020207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30757700Medicaid
WIP00301242Medicare ID - Type UnspecifiedTRAVELERS MC
WI000171118Medicare ID - Type Unspecified
WI30757700Medicaid
WIB54939Medicare UPIN