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General NPI Number Information
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NPI Number | 1811913130
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Entity Type | Individual
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Provider Name | SUSAN E MACKINNON MD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 4921 PARKVIEW PL DIV SURG PLASTICS, STE 6G
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1032
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Country | US
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Telephone | 314-362-7388
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Fax | 833-301-0853
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 314-362-7388
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Fax | 833-301-0853
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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 | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number | 102027
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 102027
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 102027
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License Number State | MO
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