Provider Demographics
NPI:1922083724
Name:MACARANAS, DOMINIC M (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:M
Last Name:MACARANAS
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 1:11307 N VIA MILANO WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-8840
Mailing Address - Country:US
Mailing Address - Phone:559-449-3240
Mailing Address - Fax:559-449-3240
Practice Address - Street 1:115 MALL DR
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5786
Practice Address - Country:US
Practice Address - Phone:559-537-1670
Practice Address - Fax:559-537-1678
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104602207R00000X
CAC54002207R00000X, 207RH0002X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05532012OtherBCBS OF ILLINOIS
IL0361046022Medicaid
IL0361046022Medicaid
IL05532012OtherBCBS OF ILLINOIS