Healthcare Provider Details

I. General information

NPI: 1295753556
Provider Name (Legal Business Name): JAMES L DONAHUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 W MICHIGAN AVE ALLEGIANCE SENIOR HEALTH CENTER
JACKSON MI
49202-4158
US

IV. Provider business mailing address

PO BOX 67000 DEPT. 272801
DETROIT MI
48267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-6001
  • Fax:
Mailing address:
  • Phone: 517-841-7490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34579
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number34579
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301093611
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: