Healthcare Provider Details

I. General information

NPI: 1437133378
Provider Name (Legal Business Name): MARK M MACELWEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E ROOSEVELT ST
PHOENIX AZ
85008
US

IV. Provider business mailing address

555 PROSPECT AVE
ESTES PARK CO
80517-6312
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-1119
  • Fax: 602-344-1112
Mailing address:
  • Phone: 970-586-2200
  • Fax: 970-577-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR40558
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number26806
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: