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Individual

JACQUELINE K MACKNIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6769
(248) 423-3144
Mailing address
3601 W 13 MILE RD, 400 FSC - PCS, ROYAL OAK, MI 48073-6769
(248) 898-5969

Taxonomy

Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
4301067705
MI
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
4301067705
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
220F349850
BCBSM
MI
05
4634690
MI
Enumeration date
03/24/2006
Last updated
06/15/2011
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