Provider Demographics
NPI:1598381295
Name:MACY, LAURA MARIE (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:MACY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY SUITE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804
Mailing Address - Country:US
Mailing Address - Phone:260-927-2175
Mailing Address - Fax:260-927-1772
Practice Address - Street 1:510 SMALTZ WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-1412
Practice Address - Country:US
Practice Address - Phone:260-927-1756
Practice Address - Fax:260-927-1772
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11021257A207Q00000X
IN02006539A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine