MEDICARE: MARY A MACSALKA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	16156	CO

General Provider Information

NPI Number	:	1205942422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY A MACSALKA M.D.

Provider Business Mailing Address
First Line	:	4745 ARAPAHOE AVE STE 110
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-1082
Country	:	US
Telephone Number	:	303-444-5110
Fax Number	:	303-444-7457

Provider Business Practice Location Address
First Line	:	4745 ARAPAHOE AVE STE 110
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-1082
Country	:	US
Telephone Number	:	303-444-5110
Fax Number	:	303-444-7457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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