Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 56470-20 | WI |
N | 2080P0202X | Pediatric Cardiologist | R2913 | TX |
N | 2080P0203X | Pediatric Critical Care Doctor | 56470 | WI |
Y | 2080P0203X | Pediatric Critical Care Doctor | ME140887 | FL |
NPI | 1053553966 |
---|---|
Provider Name | Chad Aaron Mackman |
First Address | Gainesville, FL 32610-3003 |
Second Address | Orlando, FL 32803-1248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2009 |
Last Update Date | 20/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10535553966 | (05) | WI |