Provider Demographics
NPI:1427196625
Name:MACDONALD, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 SUTTER STREET
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102
Mailing Address - Country:US
Mailing Address - Phone:415-956-3223
Mailing Address - Fax:415-956-3210
Practice Address - Street 1:500 SUTTER STREET
Practice Address - Street 2:SUITE 430
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102
Practice Address - Country:US
Practice Address - Phone:415-956-3223
Practice Address - Fax:415-956-3210
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA53976207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539761Medicare PIN