Provider Demographics
NPI:1558749770
Name:PULLEE, MACKENZIE (DO)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:
Last Name:PULLEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 SYCAMORE ST APT 2P
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2536
Mailing Address - Country:US
Mailing Address - Phone:909-835-7874
Mailing Address - Fax:
Practice Address - Street 1:634 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2535
Practice Address - Country:US
Practice Address - Phone:513-558-2426
Practice Address - Fax:513-558-0995
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH34013925207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program