Provider Demographics
NPI:1174941116
Name:MACSUGA, JESSICA ELIZABETH (DPM)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:MACSUGA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-0480
Mailing Address - Country:US
Mailing Address - Phone:810-653-9060
Mailing Address - Fax:810-658-2248
Practice Address - Street 1:605 S STATE RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1515
Practice Address - Country:US
Practice Address - Phone:810-653-9060
Practice Address - Fax:810-658-2248
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-06
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5901002547213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program