Provider Demographics
NPI:1366692287
Name:MACNEAL, JAMES JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOHN
Last Name:MACNEAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 MILL ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-2155
Mailing Address - Country:US
Mailing Address - Phone:920-531-2030
Mailing Address - Fax:920-531-2016
Practice Address - Street 1:1405 MILL ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-2155
Practice Address - Country:US
Practice Address - Phone:920-531-2030
Practice Address - Fax:920-531-2016
Is Sole Proprietor?:No
Enumeration Date:2008-09-28
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036129701207PE0004X
WI56837-21207PE0004X
WI56837207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIMACNEJAMOtherMERCYCARE INSURANCE
WI1366692287Medicaid
WI1366692287OtherBCBSWI
WI1366692287OtherBCBSWI
WI1366692287OtherBCBSWI