Provider Demographics
NPI:1447291059
Name:MACKSOOD, MICHAEL J (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MACKSOOD
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:13286 LAKESIDE LNDG
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1130
Mailing Address - Country:US
Mailing Address - Phone:810-232-8888
Mailing Address - Fax:810-232-9190
Practice Address - Street 1:1121 W HILL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4733
Practice Address - Country:US
Practice Address - Phone:810-232-8888
Practice Address - Fax:810-232-9190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007895208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI086808OtherSELECTCARE
MI204015OtherMCLAREN HEATLH PLAN
MI3452508495OtherHEALTHPLUS OF MICHIGAN
MIB444424OtherHAP
MIC1662OtherMCARE
MI086808OtherSELECTCARE
MI3452508495OtherHEALTHPLUS OF MICHIGAN