MEDICARE: MACKINSON PHILEUS

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	171W00000X	Contractor		FL

General Provider Information

NPI Number	:	1356214258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKINSON PHILEUS

Provider Business Mailing Address
First Line	:	3947 ISLAND CLUB CIR W
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2183
Country	:	US
Telephone Number	:	561-895-3780
Fax Number	:

Provider Business Practice Location Address
First Line	:	714 BARNETT DR BAY 23
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33461-3357
Country	:	US
Telephone Number	:	561-895-3780
Fax Number	:

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

Provider Enumeration Date	:	09/26/2025
Last Update Date	:	10/24/2025

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Directions to “ MACKINSON PHILEUS ” Practice Location

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