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General NPI Number Information
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NPI Number | 1215901764
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Entity Type | Individual
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Provider Name | CHARLES C MACDONALD II M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 55510 INDIAN LAKE ROAD
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City | DOWAGIAC
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State | MI
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Zip | 49047
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Country | US
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Telephone | 630-405-8753
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 ASHBURY CIR
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City | LEMONT
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State | IL
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Zip | 60439-8433
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Country | US
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Telephone | 630-405-8753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 22066-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 01037362A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 4301034118
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License Number State | MI
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