Provider Demographics
NPI:1508140187
Name:MACKO, DONALD STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:STEPHEN
Last Name:MACKO
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 1:3138 KOBROCK WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3610
Mailing Address - Country:US
Mailing Address - Phone:916-972-0603
Mailing Address - Fax:
Practice Address - Street 1:3138 KOBROCK WAY
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3610
Practice Address - Country:US
Practice Address - Phone:916-972-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42850207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery