Provider Demographics
NPI:1497003305
Name:JUDY A MACY MD PC
Entity Type:Organization
Organization Name:JUDY A MACY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-457-0455
Mailing Address - Street 1:167 COLE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4106
Mailing Address - Country:US
Mailing Address - Phone:734-457-0455
Mailing Address - Fax:734-457-0695
Practice Address - Street 1:167 COLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4106
Practice Address - Country:US
Practice Address - Phone:734-457-0455
Practice Address - Fax:734-457-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407155174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102649578Medicaid
MI0580154Medicare PIN