MEDICARE: DR. ASHLEY PATRICIA MACDONALD D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	125063671	IL

General Provider Information

NPI Number	:	1053750851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY PATRICIA MACDONALD D.O.

Provider Business Mailing Address
First Line	:	PO BOX 19670
Second Line	:	520 N FOURTH ST
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9670
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 N FOURTH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9670
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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