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NPI Code Detail

MEDICARE: DR. TIFFANY MAE MACDONALD MD

MEDICARE: DR. TIFFANY MAE MACDONALD MD
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
1207Q00000XFamily Medicine Physician77680MN

General Provider Information

NPI Number : 1184203978
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIFFANY MAE MACDONALD MD
Provider Business Mailing Address
First Line : PO BOX 43
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55440-0043
Country : US
Telephone Number : 612-262-1166
Fax Number : 612-262-4258
Provider Business Practice Location Address
First Line : 17489 DODD BLVD
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-6506
Country : US
Telephone Number : 952-428-1020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2021
Last Update Date : 11/26/2024

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Directions to “ DR. TIFFANY MAE MACDONALD MD” Practice Location

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