TRISTAN MICHEAL MACKEY MD NPI 1104576115

NPI Information

NPI: 1104576115
Provider Name: TRISTAN MICHEAL MACKEY, MD
Classification: Student in an Organized Health Care Education/Training Program - 390200000X
Entity Type: Individual
Address:
530 NE GLEN OAK AVE
PEORIA, IL
ZIP 61637
Phone: (803) 246-9689
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Tristan Micheal Mackey, MD is a student in an organized health care education training program in Peoria, IL. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. Tristan Micheal Mackey, MD NPI is 1104576115. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

530 NE GLEN OAK AVE
PEORIA, IL
ZIP 61637-001
Phone: (803) 246-9689

The enumeration date for this NPI number is 3/24/2022 and was last updated on 3/24/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program			ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

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