MEDICARE: KIM C MACKEY MD

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	208M00000X	Hospitalist Physician	MD61604924	WA
2	207V00000X	Obstetrics & Gynecology Physician	MD61604924	WA
3	207V00000X	Obstetrics & Gynecology Physician	43887	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285603431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM C MACKEY MD

Provider Business Mailing Address
First Line	:	1700 TUTTLE ST
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-3319
Country	:	US
Telephone Number	:	608-355-3800
Fax Number	:	608-355-7001

Provider Business Practice Location Address
First Line	:	22 ROULSTON RD
Second Line	:
City	:	WINDHAM
State	:	NH
Zip	:	03087-1209
Country	:	US
Telephone Number	:	608-575-4519
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	10/31/2025

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