Provider Demographics
NPI:1043295066
Name:MACIULIS, ALGIMANTAS P (MD)
Entity Type:Individual
Prefix:DR
First Name:ALGIMANTAS
Middle Name:P
Last Name:MACIULIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S. WENONA ST.
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-894-6040
Mailing Address - Fax:989-892-3983
Practice Address - Street 1:200 S. WENONA ST
Practice Address - Street 2:SUITE 260
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-894-6040
Practice Address - Fax:989-892-3983
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056481207RR0500X
MIAM056481207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2678097Medicaid
MI1100975472OtherBCR & BCN
C64638Medicare UPIN
MI2678097Medicaid