Provider Demographics
NPI:1922613793
Name:MACKIE, FATMEH
Entity Type:Individual
Prefix:
First Name:FATMEH
Middle Name:
Last Name:MACKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10037 BURLEY ST APT B3
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1671
Mailing Address - Country:US
Mailing Address - Phone:734-556-7701
Mailing Address - Fax:
Practice Address - Street 1:10037 BURLEY ST APT B3
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1671
Practice Address - Country:US
Practice Address - Phone:734-556-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9390840Medicaid