Provider Demographics
NPI:1730104993
Name:MACKINNON, ANDREW IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:IAN
Last Name:MACKINNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1715 MCCULLOUGH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4046
Mailing Address - Country:US
Mailing Address - Phone:210-558-0122
Mailing Address - Fax:210-558-0115
Practice Address - Street 1:1715 MCCULLOUGH AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4046
Practice Address - Country:US
Practice Address - Phone:210-558-0122
Practice Address - Fax:210-558-0115
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI44788-020207R00000X
KYKY43702207RC0000X, 207RI0011X
TXN1750207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB154710OtherWELLMED NETWORKS INC