Healthcare Provider Details

I. General information

NPI: 1831135045
Provider Name (Legal Business Name): JOHN C. MACMASTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N BARLOW RD
HARRISVILLE MI
48740-9607
US

IV. Provider business mailing address

PO BOX 279
LINCOLN MI
48742-0279
US

V. Phone/Fax

Practice location:
  • Phone: 989-736-8157
  • Fax: 989-358-3762
Mailing address:
  • Phone: 989-736-3020
  • Fax: 989-736-8278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101009518
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: