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General NPI Number Information
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NPI Number | 1407883093
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Entity Type | Individual
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Provider Name | WILLIAM BURGESS MACDONALD M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 2000 E LAYTON AVE
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City | ST FRANCIS
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State | WI
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Zip | 53235-6053
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Country | US
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Telephone | 414-744-6508
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 38163-020
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License Number State | WI
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