Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 37314 | AZ |
N | 207RP1001X | Pulmonary Disease | 015849 | ME |
Y | 207RP1001X | Pulmonary Disease | 2006007765 | MO |
NPI | 1053359158 |
---|---|
Provider Name | Dr. Cielo Marie Maca |
First Address | Ozark, MO 65721-6613 |
Second Address | Mount Vernon, MO 65712-1004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 03/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
301960099 | (05) | ME |
H67329 | (02) | ME |