Healthcare Provider Details

I. General information

NPI: 1760489702
Provider Name (Legal Business Name): EUGENE M MACDONALD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 523882 C/O THE MAILBOX #10649
MIAMI FL
33152-7604
US

IV. Provider business mailing address

PO BOX 523882 C/O THE MAILBOX #10649
MIAMI FL
33152-7604
US

V. Phone/Fax

Practice location:
  • Phone: 317-827-2987
  • Fax: 317-219-0879
Mailing address:
  • Phone: 317-827-2987
  • Fax: 317-219-0879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000615A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: