Provider Demographics
NPI:1760489702
Name:MACDONALD, EUGENE M (DPM)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:M
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 GUION ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-7604
Mailing Address - Country:US
Mailing Address - Phone:317-931-0664
Mailing Address - Fax:317-927-0924
Practice Address - Street 1:2020 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-2800
Practice Address - Country:US
Practice Address - Phone:765-662-0200
Practice Address - Fax:765-673-2301
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000615A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100123970Medicaid
IN192530JMedicare PIN
IN100123970Medicaid
IN480034542Medicare PIN
IN4685310001Medicare NSC