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General NPI Number Information
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NPI Number | 1295982668
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Entity Type | Individual
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Provider Name | RYAN THOMAS MACKEY DPM
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Gender | Male
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 12/09/2016
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Provider Practice Location Address
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Address Line | 1001 W MAIN ST
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City | WAUPUN
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State | WI
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Zip | 53963-1601
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Country | US
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Telephone | 920-361-3063
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Fax | 920-361-7317
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Provider Business Mailing Address
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Address Line | 1001 W MAIN ST
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City | WAUPUN
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State | WI
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Zip | 53963-1601
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Country | US
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Telephone | 920-324-9301
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Fax | 920-324-9473
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD-0000708
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License Number State | CO
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