Provider Demographics
NPI:1619157161
Name:MCDONALD, MICHAEL HEALY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HEALY
Last Name:MCDONALD
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 1:202 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6408 COPPS AVE
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3702
Practice Address - Country:US
Practice Address - Phone:608-417-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19788-020207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI040004902OtherRAILROAD MEDICARE
WI100403OtherPHYSICIANS PLUS INS CO
WI30423300Medicaid
WI564927OtherDEAN HEALTH PLAN VENDOR #
WI040004902OtherRAILROAD MEDICARE
WI564927OtherDEAN HEALTH PLAN VENDOR #
WI30423300Medicaid
WI100403OtherPHYSICIANS PLUS INS CO