Active NPI
Thomas Macholan, MD
- Family Medicine Physician
- Grandville, MI
National Provider Identifier
1093768574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301044818
- Practice address
- 3380 44TH St SW
Grandville, MI 49418-2461 - Phone
- (616) 685-8250
- Fax
- (616) 532-9564
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301044818 | MI | Primary |
Addresses
Primary practice location
3380 44TH St SW
Grandville, MI 49418-2461
Mailing address
245 State St SE
Grand Rapids, MI 49503-4328
Phone (616) 685-1808
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2900180 | Medicaid | MI | |
| 3415715 | Medicaid | MI | |
| 4187712 | Medicaid | MI | |
| 4187730 | Medicaid | MI | |
| 4160942 | Medicaid | MI | |
| 4876824 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246233600000",
"number": "1093768574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 STATE ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034328",
"telephone_number": "616-685-1808",
"fax_number": "616-685-1850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3380 44TH ST SW",
"city": "GRANDVILLE",
"state": "MI",
"postal_code": "494182461",
"telephone_number": "616-685-8250",
"fax_number": "616-532-9564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACHOLAN",
"first_name": "THOMAS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2009-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301044818",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2900180",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3415715",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4187712",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4187730",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4160942",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4876824",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grandville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.