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NPI Code Detail

MEDICARE: KAITLINN PATRICIA MACIEISKI MD

MEDICARE: KAITLINN PATRICIA MACIEISKI 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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician324918LA

General Provider Information

NPI Number : 1790245454
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLINN PATRICIA MACIEISKI MD
Provider Business Mailing Address
First Line : 650 JOEL DR
Second Line :
City : FORT CAMPBELL
State : KY
Zip : 42223-8355
Country : US
Telephone Number : 270-798-8400
Fax Number :
Provider Business Practice Location Address
First Line : 650 JOEL DR
Second Line :
City : FORT CAMPBELL
State : KY
Zip : 42223-8355
Country : US
Telephone Number : 270-798-8400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 06/10/2026

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Directions to “ KAITLINN PATRICIA MACIEISKI MD” Practice Location

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