MEDICARE: DR. MICHAEL S MCDONNELL 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	207V00000X	Obstetrics & Gynecology Physician	MM012522	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164412961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL S MCDONNELL D.O.

Provider Business Mailing Address
First Line	:	306 W WASHINGTON AVE
Second Line	:	STE 102
City	:	JACKSON
State	:	MI
Zip	:	49201-2176
Country	:	US
Telephone Number	:	517-787-0334
Fax Number	:	517-787-2114

Provider Business Practice Location Address
First Line	:	300 W WASHINGTON AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-2180
Country	:	US
Telephone Number	:	517-787-0334
Fax Number	:	517-787-2114

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	03/11/2008

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Directions to “ DR. MICHAEL S MCDONNELL D.O.” Practice Location

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