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NPI Code Detail

MEDICARE: DR. JOHN W MCDONOUGH II DO

MEDICARE: DR. JOHN W MCDONOUGH II DO
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
1207X00000XOrthopaedic Surgery Physician19291WI
2207XX0005XSports Medicine (Orthopaedic Surgery) Physician19291WI

Other Identifiers

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

General Provider Information

NPI Number : 1700879525
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN W MCDONOUGH II DO
Provider Business Mailing Address
First Line : 1000 N OAK AVE
Second Line :
City : MARSHFIELD
State : WI
Zip : 54449-5703
Country : US
Telephone Number : 715-387-5511
Fax Number :
Provider Business Practice Location Address
First Line : 410 DEWEY ST
Second Line :
City : WISCONSIN RAPIDS
State : WI
Zip : 54495-8075
Country : US
Telephone Number : 715-421-5257
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2005
Last Update Date : 04/12/2012

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