MEDICARE: DR. TIMOTHY DONALD MACON D.O.,F.C.C.P.

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	207RP1001X	Pulmonary Disease Physician	TM009037	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110216075	OTHER	MI	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	115651012	OTHER	MI	BLUE CROSS BLUE SHIELD
2	302002	OTHER	MA	CENTRAL HEALTH PLAN OF MI
3	4509887	OTHER	MI	AETNA
5	383563124	OTHER	MI	PPOM
6	383563124	OTHER	MI	UNITED HEALTH PLAN
7	1007603	OTHER	MI	MCLAREN HEALTH PLAN
8	383563124101	OTHER	MI	COMMUNITY CHOICE OF MICH
9	1000781	OTHER	MA	MCLAREN HEALTH ADVANTAGE
10	122278	OTHER	MI	PREFERRED CHOICE
11	383563124	OTHER	MI	UNITED HEALTH CARE
12	115651012	OTHER	MI	BLUE CARE NETWORK
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679561443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY DONALD MACON D.O.,F.C.C.P.

Provider Business Mailing Address
First Line	:	780 N GAVORD RD
Second Line	:
City	:	STERLING
State	:	MI
Zip	:	48659-9703
Country	:	US
Telephone Number	:	989-654-2168
Fax Number	:	989-654-2825

Provider Business Practice Location Address
First Line	:	780 N GAVORD RD
Second Line	:
City	:	STERLING
State	:	MI
Zip	:	48659-9703
Country	:	US
Telephone Number	:	989-654-2168
Fax Number	:	989-654-2825

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	10/23/2020

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