Individual
DR. RYAN THOMAS MACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1001 W MAIN ST, WAUPUN, WI 53963-1601
(920) 361-3063
(920) 361-7317
Mailing address
1001 W MAIN ST, WAUPUN, WI 53963-1601
(920) 324-9301
(920) 324-9473
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD-0000708
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305219302
—
TX
01
—
P01735659
RAILROAD MEDICARE
CO
01
—
P01736047
RAILROAD MEDICARE
TX
Enumeration date
08/27/2008
Last updated
12/09/2016
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