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NPI Code Detail

MEDICARE: JOHN DOUGLAS MACDONALD MD

MEDICARE: JOHN DOUGLAS 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
1207R00000XInternal Medicine Physician27025WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
127025OTHERWILICENSE

General Provider Information

NPI Number : 1467437715
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN DOUGLAS MACDONALD MD
Provider Business Mailing Address
First Line : PO BOX 1866
Second Line :
City : GREEN BAY
State : WI
Zip : 54305-1866
Country : US
Telephone Number : 920-445-7222
Fax Number : 920-445-7289
Provider Business Practice Location Address
First Line : 820 ARBUTUS AVE
Second Line :
City : OCONTO
State : WI
Zip : 54153-2004
Country : US
Telephone Number : 920-835-1100
Fax Number : 920-835-1099
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2005
Last Update Date : 02/15/2022

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