Individual
DR. JENNIFER CICHON MACKINNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-109295
IL
207R00000X
Internal Medicine Physician
Primary
55041
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316985427
—
WI
Enumeration date
06/02/2006
Last updated
05/18/2012
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