Individual
MACKENZIE ANNE MCCROREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085003524
IL
363AS0400X
Surgical Physician Assistant
085003524
IL
363AS0400X
Surgical Physician Assistant
Primary
PA195380
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE (GROUP PTAN)
IL
01
—
206147235
MEDICARE (INDIVIDUAL)
IL
01
—
CA4748
MEDICARE RAILROAD (GROUP PTAN)
IL
01
—
P01216933
MEDICARE RAILROAD (PROVIDER PTAN)
IL
Enumeration date
07/03/2008
Last updated
01/10/2023
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