Provider Demographics
NPI:1144293242
Name:MACIK, FELICIA KAY (DO)
Entity type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:KAY
Last Name:MACIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:K
Other - Last Name:FILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1000 STATE HIGHWAY 6
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3787
Mailing Address - Country:US
Mailing Address - Phone:254-339-1360
Mailing Address - Fax:844-273-3037
Practice Address - Street 1:1000 STATE HIGHWAY 6
Practice Address - Street 2:SUITE 100
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3787
Practice Address - Country:US
Practice Address - Phone:254-339-1360
Practice Address - Fax:844-273-3037
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10104748OtherDPS
TX040040004Medicaid
BM5848049OtherDEA
TX040040004Medicaid
BM5848049OtherDEA