Individual provider Active NPI

Michael Donohoo, DDS

  • General Practice Dentistry
  • Milwaukee, WI
National Provider Identifier
1275628638
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2503 Issued in WI
Practice address
7623 W Burleigh St
Milwaukee, WI 53222-5001
Phone
(414) 444-4334
Fax
(414) 444-3222
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2503 WI Primary

Addresses

Primary practice location

7623 W Burleigh St
Milwaukee, WI 53222-5001

Mailing address

7623 W Burleigh St
Milwaukee, WI 53222-5001
Phone (414) 444-4334

Other identifiers 1

IdentifierTypeStateIssuer
33409300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150702000034 WI Order and Referring Only - Other (Non-Physician) 1850603945

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2503WIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Burleigh Dental, SC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275628638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7623 W BURLEIGH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532225001",
            "telephone_number": "414-444-4334",
            "fax_number": "414-444-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7623 W BURLEIGH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532225001",
            "telephone_number": "414-444-4334",
            "fax_number": "414-444-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONOHOO",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33409300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.