Provider Demographics
NPI:1679561443
Name:MACON, TIMOTHY DONALD (DO,FCCP)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DONALD
Last Name:MACON
Suffix:
Gender:M
Credentials:DO,FCCP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:780 N GAVORD RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MI
Mailing Address - Zip Code:48659-9703
Mailing Address - Country:US
Mailing Address - Phone:989-654-2168
Mailing Address - Fax:989-654-2825
Practice Address - Street 1:780 N GAVORD RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MI
Practice Address - Zip Code:48659-9703
Practice Address - Country:US
Practice Address - Phone:989-654-2168
Practice Address - Fax:989-654-2825
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MITM009037207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI115651012OtherBLUE CROSS BLUE SHIELD
MA302002OtherCENTRAL HEALTH PLAN OF MI
MI4509887OtherAETNA
MI110216075OtherRAIL ROAD MEDICARE
MI383563124OtherPPOM
MI383563124OtherUNITED HEALTH PLAN
MI1007603OtherMCLAREN HEALTH PLAN
MI383563124101OtherCOMMUNITY CHOICE OF MICH
MA1000781OtherMCLAREN HEALTH ADVANTAGE
MI122278OtherPREFERRED CHOICE
MI383563124OtherUNITED HEALTH CARE
MI115651012OtherBLUE CARE NETWORK
MI4261168Medicaid
MI122278OtherPREFERRED CHOICE
MA302002OtherCENTRAL HEALTH PLAN OF MI
MIF04781Medicare UPIN