MEDICARE: STEVEN C MACKO 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	207Q00000X	Family Medicine Physician	29415	AZ

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	:	1639155070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN C MACKO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	520-494-7778
Fax Number	:	520-494-7779

Provider Business Practice Location Address
First Line	:	21300 N JOHN WAYNE PKWY STE 123
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85139-8978
Country	:	US
Telephone Number	:	204-947-7785
Fax Number	:	520-494-7779

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	11/22/2023

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