=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841256658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL K. ACKLAND, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2006
-----------------------------------------------------
Last Update Date | 11/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 449 ROUTE 130 STE 8
-----------------------------------------------------
City | SANDWICH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-888-6907
-----------------------------------------------------
Fax | 508-888-6948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 449 ROUTE 130 STE 8
-----------------------------------------------------
City | SANDWICH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-888-6907
-----------------------------------------------------
Fax | 508-888-6948
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL KINGSLEY ACKLAND
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 508-888-6907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 1845471
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 76697
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------