MEDICARE: MICHAEL JOSEPH MACDONALD DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	OS 6245	FL

General Provider Information

NPI Number	:	1346232972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH MACDONALD DO

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 GATEWAY DR STE 2H
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2607
Country	:	US
Telephone Number	:	321-434-8878
Fax Number	:	321-434-8881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	10/31/2018

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