Provider Demographics
NPI:1215947130
Name:MACKE, ANN REED (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:REED
Last Name:MACKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5561
Mailing Address - Country:US
Mailing Address - Phone:859-525-8181
Mailing Address - Fax:859-525-8289
Practice Address - Street 1:7309 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5561
Practice Address - Country:US
Practice Address - Phone:859-525-8181
Practice Address - Fax:859-525-8289
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY367572080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65932758Medicaid