Individual provider · NPI-1

Mark Jeffrey Mcdonald, a.t.c.

Specialist/Technologist, Athletic Trainer · Southgate, MI

NPI number1114075892
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1114075892
Entity type
Individual (NPI-1)
Name
Mark Jeffrey Mcdonald
Credential
a.t.c.
Sex
Male
Sole proprietor
Yes
Enumeration date
Jan 8, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer––Yes

Practice location

15777 Northline Rd
Suite 102
Southgate, MI 48195-2385

Phone 734-246-8125 · Fax 734-246-8113

Mailing address

15777 Northline Rd
Suite 102
Southgate, MI 48195-2385

Phone 734-246-8125 · Fax 734-246-8113

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