Provider Demographics
NPI:1013158658
Name:MACKEY, RENEE LENORE (DPM)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:LENORE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 STATE ROUTE 59 STE D
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4112
Mailing Address - Country:US
Mailing Address - Phone:330-673-3505
Mailing Address - Fax:330-673-4888
Practice Address - Street 1:2950 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3614
Practice Address - Country:US
Practice Address - Phone:330-864-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003579213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000718318OtherANTHEM
OH0052496Medicaid
OH30-0506709OtherUNITED HEALTHCARE
OH9047186OtherSUMMA
OH1013158658OtherMEDICAL MUTUAL
OH30-0506709OtherCARESOURCE
OHP00980802OtherRR MEDICARE
OH2286732OtherCOVENTRY HEALTHCARE/FIRST HEALTH NETWORK
OH8848863OtherCIGNA
OH9486718OtherAETNA
OH30-0506709OtherHOMETOWN
OH9047186OtherSUMMA
OH000000718318OtherANTHEM
OH0052496Medicaid