Provider Demographics
NPI:1861460750
Name:MCDONALD, PERCY (MD08)
Entity Type:Individual
Prefix:DR
First Name:PERCY
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD08
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 STONE STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:810-984-4400
Mailing Address - Fax:
Practice Address - Street 1:1107 STONE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3569
Practice Address - Country:US
Practice Address - Phone:810-984-4400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051044207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1832639Medicaid
MI07409477042Medicare ID - Type Unspecified
MI1832639Medicaid