Individual
DR. THEODORE G MACKINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9200 W WISCONSIN AVE, DEPARTMENT OF INTERNAL MEDICINE, MILWAUKEE, WI 53226-3522
(414) 805-6850
(414) 805-6851
Mailing address
9200 W WISCONSIN AVE, DEPARTMENT OF INTERNAL MEDICINE, MILWAUKEE, WI 53226-3522
(414) 805-6850
(414) 805-6851
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
32030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002000125I
HUMANA
—
05
—
1033162763
—
WI
Enumeration date
05/17/2006
Last updated
10/03/2013
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