Provider Demographics
NPI:1548276066
Name:MACKEL, AUDLEY MAURICE III (MD)
Entity type:Individual
Prefix:DR
First Name:AUDLEY
Middle Name:MAURICE
Last Name:MACKEL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5 SEVERANCE CIR
Mailing Address - Street 2:SUITE 609
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-691-9000
Mailing Address - Fax:216-691-9207
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:SUITE 609
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-691-9000
Practice Address - Fax:216-691-9207
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35056726207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0703877Medicaid
A17476Medicare UPIN
OH0703877Medicaid