Provider Demographics
NPI:1720231889
Name:MCKAIN, MAILE FISCUS (LAC, DIPL OM)
Entity Type:Individual
Prefix:MS
First Name:MAILE
Middle Name:FISCUS
Last Name:MCKAIN
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BITNER RD
Mailing Address - Street 2:L-33
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5404
Mailing Address - Country:US
Mailing Address - Phone:435-602-9750
Mailing Address - Fax:
Practice Address - Street 1:1960 SIDEWINDER DR
Practice Address - Street 2:SUITE 206
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7329
Practice Address - Country:US
Practice Address - Phone:435-602-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5194233-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist