MEDICARE: DR. RACHEL DONALDSON M.D.

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	207RN0300X	Nephrology Physician	4301406139	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4301406139	OTHER	MI	STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528164316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL DONALDSON M.D.

Provider Business Mailing Address
First Line	:	19445 AFTON RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48203-1437
Country	:	US
Telephone Number	:	313-574-5430
Fax Number	:	734-353-4108

Provider Business Practice Location Address
First Line	:	19800 WOODWARD AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48203-5102
Country	:	US
Telephone Number	:	313-893-8610
Fax Number	:

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	11/21/2011

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