Individual
CHRISTINE M MACKIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4304 DEL PRADO BLVD S, CAPE CORAL, FL 33904-7169
(239) 540-0800
(239) 540-0806
Mailing address
4304 DEL PRADO BLVD S, CAPE CORAL, FL 33904-7169
(239) 540-0800
(239) 540-0806
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME94225
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273771000
—
FL
01
—
29322
BC/BS
FL
01
—
CC4198
RAILROAD MEDICARE GROUP #
FL
01
—
P00379350
RAILROAD MEDICARE PIN
FL
Enumeration date
11/02/2005
Last updated
10/29/2020
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