Provider Demographics
NPI:1811904923
Name:MACKAY, ALLAN ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:ALEXANDER
Last Name:MACKAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N CURRY PIKE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-2593
Mailing Address - Country:US
Mailing Address - Phone:812-339-5424
Mailing Address - Fax:812-339-5413
Practice Address - Street 1:100 N CURRY PIKE
Practice Address - Street 2:A1
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-2593
Practice Address - Country:US
Practice Address - Phone:812-339-5424
Practice Address - Fax:812-339-5413
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062200A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200830920AMedicaid
IN000000537577OtherBLUE CROSS/BLUE SHIELD
INI64918Medicare UPIN
IN200830920AMedicaid