Individual
PATRICK ANDREW MACKNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 482-5091
Mailing address
608 UNION CHAPEL RD, FORT WAYNE, IN 46845-9357
(260) 482-5091
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001054A
IN
363A00000X
Physician Assistant
Primary
PENDING
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000614685
ANTHEM
IN
01
—
P00755205
MEDICARE RR
IN
Enumeration date
12/01/2008
Last updated
03/30/2026
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