Healthcare Provider Details

I. General information

NPI: 1558400150
Provider Name (Legal Business Name): MACON COUNTY MEDICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2981 N MAIN ST
DECATUR IL
62526-3259
US

IV. Provider business mailing address

2981 N MAIN ST
DECATUR IL
62526-3259
US

V. Phone/Fax

Practice location:
  • Phone: 217-877-9775
  • Fax: 217-877-9806
Mailing address:
  • Phone: 217-877-9775
  • Fax: 217-877-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number060005046
License Number StateIL

VIII. Authorized Official

Name: GAURANG P PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 217-877-9775