Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 19788-020 | WI |
NPI | 1619157161 |
---|---|
Provider Name | Dr. Michael Healy Mcdonald |
First Address | Madison, WI 53715-1507 |
Second Address | Monona, WI 53716-3702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2007 |
Last Update Date | 04/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040004902 | RAILROAD MEDICARE (01) | WI |
100403 | PHYSICIANS PLUS INS CO (01) | WI |
30423300 | (05) | WI |
564927 | DEAN HEALTH PLAN VENDOR # (01) | WI |
B54940 | (02) | WI |