MEDICARE: JOHN M MCILDUFF M.D.

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	2086S0129X	Vascular Surgery Physician	JM045495	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105269	OTHER	MI	CARE CHOICE HMO
2	204105	OTHER	MI	MCLAREN HEALTH PLAN/ADVAN
3	B43079	OTHER	MI	HEALTH ALLIANCE PLAN
4	C3731	OTHER	MI	M-CARE
5	105269	OTHER	MI	PREFERRED CHOICE PPO
6	382237803109	OTHER	MI	COMMUNITY CHOICE
7	0108141	OTHER	MI	HEALTHPLUS OF MICHIGAN
8	0202508141	OTHER	MI	BC/BS OF MICHIGAN
9	113646	OTHER	MI	GREAT LAKE HEALTH PLAN
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	4294624	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1548231004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN M MCILDUFF M.D.

Provider Business Mailing Address
First Line	:	5020 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2919
Country	:	US
Telephone Number	:	810-732-1620
Fax Number	:	810-732-8559

Provider Business Practice Location Address
First Line	:	5020 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2919
Country	:	US
Telephone Number	:	810-732-1620
Fax Number	:	810-732-8559

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	11/27/2007

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Directions to “ JOHN M MCILDUFF M.D.” Practice Location

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