MEDICARE: MICHELLE MARIE MACDONALD PA-C

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	363A00000X	Physician Assistant	5601003032	MI

General Provider Information

NPI Number	:	1194819003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MARIE MACDONALD PA-C

Provider Business Mailing Address
First Line	:	6227 FRANKFORT HWY
Second Line	:
City	:	BENZONIA
State	:	MI
Zip	:	49616-8632
Country	:	US
Telephone Number	:	231-882-9661
Fax Number	:	231-882-1049

Provider Business Practice Location Address
First Line	:	93 W 4TH ST STE B
Second Line	:
City	:	SUTTONS BAY
State	:	MI
Zip	:	49682-8408
Country	:	US
Telephone Number	:	231-866-4440
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	01/15/2020

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