Healthcare Provider Details

I. General information

NPI: 1215947130
Provider Name (Legal Business Name): ANN REED MACKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7309 US HIGHWAY 42
FLORENCE KY
41042-5561
US

IV. Provider business mailing address

7309 US HIGHWAY 42
FLORENCE KY
41042-5561
US

V. Phone/Fax

Practice location:
  • Phone: 859-525-8181
  • Fax: 859-525-8289
Mailing address:
  • Phone: 859-525-8181
  • Fax: 859-525-8289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number36757
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: