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General NPI Number Information
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NPI Number | 1114124575
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Entity Type | Individual
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Provider Name | JOSEPH MICHAEL MACKEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 1011 WEST SECOND STREET
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2216
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Country | US
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Telephone | 812-334-1213
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Fax | 812-333-5039
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Provider Business Mailing Address
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Address Line | 1011 WEST SECOND STREET
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2216
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Country | US
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Telephone | 812-334-1213
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Fax | 812-333-5039
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01069717A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TRN11512
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License Number State | FL
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