Healthcare Provider Details

I. General information

NPI: 1265432827
Provider Name (Legal Business Name): MICHAEL H MCDONALD MDSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 DRYDEN DR
MADISON WI
53704-3015
US

IV. Provider business mailing address

3209 DRYDEN DR
MADISON WI
53704-3015
US

V. Phone/Fax

Practice location:
  • Phone: 608-241-6661
  • Fax: 608-241-6692
Mailing address:
  • Phone: 608-241-6661
  • Fax: 608-241-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number19788-020
License Number StateWI

VIII. Authorized Official

Name: DR. MICHAEL H MCDONALD
Title or Position: PRESIDENT
Credential: MD
Phone: 608-241-6661