Healthcare Provider Details

I. General information

NPI: 1679555718
Provider Name (Legal Business Name): DONALD E MCMAHON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 S ALABAMA ST STE 100
INDIANAPOLIS IN
46225-3301
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-2489
  • Fax: 317-528-3770
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01045365A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: