Healthcare Provider Details

I. General information

NPI: 1598950842
Provider Name (Legal Business Name): ALLAN MACKAY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N CURRY PIKE SUITE A1
BLOOMINGTON IN
47404
US

IV. Provider business mailing address

PO BOX 1350
BLOOMINGTON IN
47402-1350
US

V. Phone/Fax

Practice location:
  • Phone: 812-339-5424
  • Fax: 812-339-5413
Mailing address:
  • Phone: 812-339-5424
  • Fax: 812-339-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01062200A
License Number State

VIII. Authorized Official

Name: ALLAN ALEXANDER MACKAY
Title or Position: OWNER
Credential: M.D.
Phone: 812-339-5424