Diane M Mackie, DO
Individual provider Active NPI Anatomic Pathology & Clinical Pathology Physician · Bremen, IN
NPI 1972585909 · NPPES record last updated Jan 6, 2010
Key facts
- NPI
- 1972585909
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- License
- 02000864A (IN)
- Practice address
- 1020 High Rd
Bremen, IN 46506-0008 - Phone
- (574) 546-2211
- NPI assigned
- Nov 16, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02000864A | IN | MD | Anatomic Pathology & Clinical Pathology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 02000864A | IN | Yes |
Addresses
Primary practice location
1020 High Rd
Bremen, IN 46506-0008
Mailing address
5620 Southwyck Blvd
Toledo, OH 43614-1501
Phone (800) 288-8325
Other providers in Bremen, IN
- Courtney Anne Lawmaster
- Ryan Libey
- Kali Ann Loftus
- James Wellington Lowe
- Faith Mackensworth
- Alee Mannakee
- Marshall County Family Dentistry, PC
- Keyna Ann Martinez
- Michael R McClaid
- Diana Renee Mechelay
All providers in Bremen, IN · Anatomic Pathology & Clinical Pathology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.