Provider Demographics
NPI:1033107867
Name:PASSAL, DONALD B (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:PASSAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 LAPEER AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:1522 JANES AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-1819
Practice Address - Country:US
Practice Address - Phone:989-755-0316
Practice Address - Fax:989-755-0956
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2021-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301038058208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P74211OtherBLUE CARE NETWORK OF MICH
MI1033107867Medicaid
0983722OtherHEALTHPLUS OF MICHIGAN
1010623OtherMCLAREN HEALTH PLAN
160G36111OtherBCBS OF MI
2987397OtherMOLINA HEALTH CARE OF MIC
381908328OtherTRICARE
104OtherCOMMUNITY CHOICE OF MICHI
121653OtherGREAT LAKES HEALTH PLAN
160G36111OtherBCBS OF MI
381908328OtherTRICARE