Provider Demographics
NPI:1326063934
Name:MACKEN, OWEN P (DPM)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:P
Last Name:MACKEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4050 SHERIDAN ST
Mailing Address - Street 2:STE D
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3561
Mailing Address - Country:US
Mailing Address - Phone:954-961-4040
Mailing Address - Fax:954-986-4456
Practice Address - Street 1:4050 SHERIDAN ST
Practice Address - Street 2:STE D
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3561
Practice Address - Country:US
Practice Address - Phone:954-961-4040
Practice Address - Fax:954-986-4456
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP0357213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87114Medicare ID - Type Unspecified