Healthcare Provider Details

I. General information

NPI: 1023463726
Provider Name (Legal Business Name): MICHAEL ALLAN MACKECHNIE MD, CM, FAAOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2016
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 SE SALERNO RD STE 110
STUART FL
34997-6572
US

IV. Provider business mailing address

15 ENTERPRISE DR
AUGUSTA ME
04330-7997
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-2735
  • Fax: 772-781-2739
Mailing address:
  • Phone: 207-621-8700
  • Fax: 207-621-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME146666
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: