Provider Demographics
NPI:1689650103
Name:MACIULIS, MARGARETHE M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARETHE
Middle Name:M
Last Name:MACIULIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S WENONA AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-894-6040
Mailing Address - Fax:989-892-3983
Practice Address - Street 1:200 S WENONA ST
Practice Address - Street 2:SUITE 260
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-894-6040
Practice Address - Fax:989-892-3983
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056636207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1100910591OtherBCR & BCN
MI2665811Medicaid
MI2665811Medicaid
MI1100910591OtherBCR & BCN