Individual
JUDITH A MACKALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-8500
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35-063166
OH
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
35-063166
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224301
UNISON
OH
01
—
000000539430
ANTHEM
OH
01
—
0649352
AETNA
OH
05
—
0922363
—
OH
01
—
110107308
RAILROAD MEDICARE
OH
01
—
363793
WELLCARE
OH
01
—
741775
BUCKEYE
OH
01
—
P00449266
RAILROAD MEDICARE
OH
Enumeration date
07/19/2006
Last updated
12/30/2020
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