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General NPI Number Information
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NPI Number | 1295737229
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Entity Type | Individual
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Provider Name | WILLIAM DAVID MACINNES PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 4705 TOWNE CENTRE RD STE 304
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City | SAGINAW
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State | MI
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Zip | 48604-2821
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Country | US
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Telephone | 989-921-5100
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Fax | 989-921-5104
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Provider Business Mailing Address
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Address Line | 4705 TOWNE CENTRE RD STE 304
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City | SAGINAW
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State | MI
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Zip | 48604-2821
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Country | US
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Telephone | 989-921-5100
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Fax | 989-921-5104
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6301008040
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License Number State | MI
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