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1609867373

NPI Code Detail

MEDICARE: STEVEN MACKE MD

MEDICARE: STEVEN MACKE 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	207Q00000X	Family Medicine Physician	01029370	IN
2	207Q00000X	Family Medicine Physician	036056646	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00312208	OTHER	IL	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1609867373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN MACKE MD

Provider Business Mailing Address
First Line	:	PO BOX 2505
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-2505
Country	:	US
Telephone Number	:	812-238-7783
Fax Number	:	812-238-4506

Provider Business Practice Location Address
First Line	:	410 N 2ND ST
Second Line	:
City	:	MARSHALL
State	:	IL
Zip	:	62441-1010
Country	:	US
Telephone Number	:	217-826-2361
Fax Number	:	217-826-2366

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	06/11/2012

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Directions to “ STEVEN MACKE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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