Provider Demographics
NPI:1730276767
Name:MCDONALD, MICHAEL X (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:X
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CONSERVATORY DR
Mailing Address - Street 2:BUILDING D, SUITE A
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-9002
Mailing Address - Country:US
Mailing Address - Phone:330-753-0345
Mailing Address - Fax:330-753-0194
Practice Address - Street 1:62 CONSERVATORY DR
Practice Address - Street 2:BUILDING D, SUITE A
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-9002
Practice Address - Country:US
Practice Address - Phone:330-753-0345
Practice Address - Fax:330-753-0194
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-050763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0595208Medicaid
OH0595208Medicaid
MC7322771Medicare ID - Type Unspecified