Provider Demographics
NPI:1750337804
Name:MACY, JUDY A (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:A
Last Name:MACY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21950 KNUDSEN DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1345
Mailing Address - Country:US
Mailing Address - Phone:734-676-9213
Mailing Address - Fax:
Practice Address - Street 1:167 COLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4106
Practice Address - Country:US
Practice Address - Phone:734-457-0455
Practice Address - Fax:734-457-0695
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM407155208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102649578Medicaid
MI102649578Medicaid
MI102649578Medicaid