Provider Demographics
NPI:1467453464
Name:MACKEY, PAULA S (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:S
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAULA
Other - Middle Name:LOREY
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2910 CENTRE POINTE DR
Mailing Address - Street 2:STE 35-121A, CHILDREN'S HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1182
Mailing Address - Country:US
Mailing Address - Phone:651-855-2109
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:CHILDREN'S PRIMARY CLINIC - MPLS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-6107
Practice Address - Fax:612-813-7473
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN204042500Medicaid
H29153Medicare UPIN