Individual
ANDREW TAD MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1725 N 5TH ST, TERRE HAUTE, IN 47804-4010
(812) 242-3005
(812) 242-3054
Mailing address
221 S 6TH ST, TERRE HAUTE, IN 47807-4214
(812) 242-3005
(812) 242-3054
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
36113741
IL
2080S0010X
Pediatric Sports Medicine Physician
Primary
01062210A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000481762
ANTHEM
—
05
—
200826590
—
IN
05
—
351904269250
—
IN
01
—
351904269E
SAGAMORE
—
01
—
5055772
CIGNA
—
01
—
7037789
AETNA
—
05
—
N357972
—
IN
01
—
P00360017
RAILROAD MEDICARE PALAMET
—
01
—
P00866719
RAILROAD MEDICARE
IN
Enumeration date
08/20/2006
Last updated
04/13/2015
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