Healthcare Provider Details

I. General information

NPI: 1669422077
Provider Name (Legal Business Name): JOHN D MASKILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N MAIN ST
SHERIDAN MI
48884-9235
US

IV. Provider business mailing address

301 N MAIN ST
SHERIDAN MI
48884-9235
US

V. Phone/Fax

Practice location:
  • Phone: 989-291-3261
  • Fax:
Mailing address:
  • Phone: 989-291-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number4301078141
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number017156
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: