Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 36757 | KY |
NPI | 1215947130 |
---|---|
Provider Name | Dr. Ann Reed Macke |
First Address | Florence, KY 41042-5561 |
Second Address | Florence, KY 41042-5561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
65932758 | (05) | KY |