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General NPI Number Information
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NPI Number | 1871159772
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Entity Type | Individual
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Provider Name | DONALD T MCDONALD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 19475 W NORTH AVE STE 302
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City | BROOKFIELD
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State | WI
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Zip | 53045-4199
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Country | US
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Telephone | 920-573-0312
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Fax |
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Provider Business Mailing Address
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Address Line | 19475 W NORTH AVE STE 302
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City | BROOKFIELD
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State | WI
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Zip | 53045-4199
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Country | US
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Telephone | 920-573-0312
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 07001413A
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License Number State | IN
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