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NPI Code Detail

MEDICARE: VICTOR WILLIAM MACKO M.D.

MEDICARE: VICTOR WILLIAM 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
1207X00000XOrthopaedic Surgery PhysicianA44688CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10219850005OTHERCACIGNA MEDICARE PIN

General Provider Information

NPI Number : 1720085921
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTOR WILLIAM MACKO M.D.
Provider Business Mailing Address
First Line : 600 COFFEE RD
Second Line :
City : MODESTO
State : CA
Zip : 95355-4201
Country : US
Telephone Number : 209-524-1211
Fax Number :
Provider Business Practice Location Address
First Line : 2545 W HAMMER LN
Second Line :
City : STOCKTON
State : CA
Zip : 95209-2839
Country : US
Telephone Number : 209-957-7050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 10/18/2010

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