MEDICARE: JAMES P MACKRELL 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	207UN0901X	Nuclear Cardiology Physician	01065861A	IN
2	207RC0000X	Cardiovascular Disease Physician	01065861A	IN

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	:	1295713949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES P MACKRELL MD

Provider Business Mailing Address
First Line	:	330 N WABASH AVE STE 110
Second Line	:
City	:	MARION
State	:	IN
Zip	:	46952-2677
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 N WABASH AVE STE 110
Second Line	:
City	:	MARION
State	:	IN
Zip	:	46952-2677
Country	:	US
Telephone Number	:	765-664-1201
Fax Number	:

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/19/2022

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