Provider Demographics
NPI:1265432827
Name:MICHAEL H MCDONALD MDSC
Entity type:Organization
Organization Name:MICHAEL H MCDONALD MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-241-6661
Mailing Address - Street 1:3209 DRYDEN DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3015
Mailing Address - Country:US
Mailing Address - Phone:608-241-6661
Mailing Address - Fax:608-241-6692
Practice Address - Street 1:3209 DRYDEN DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3015
Practice Address - Country:US
Practice Address - Phone:608-241-6661
Practice Address - Fax:608-241-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19788-020207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
040004902OtherRAILROAD MEDICARE
WI1000403OtherPHYSICIANS PLUS HMO
WI30423300Medicaid
WI564927OtherDEAN HEALTH PLAN VENDOR #
WI564927OtherDEAN HEALTH PLAN VENDOR #
WI30423300Medicaid
B54940Medicare UPIN
WI000015016Medicare PIN