Provider Demographics
NPI:1053359158
Name:MACA, CIELO MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:CIELO MARIE
Middle Name:
Last Name:MACA
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 1:6250 CREEKSEDGE DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6613
Mailing Address - Country:US
Mailing Address - Phone:417-631-8605
Mailing Address - Fax:
Practice Address - Street 1:600 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1004
Practice Address - Country:US
Practice Address - Phone:417-461-5215
Practice Address - Fax:417-461-5729
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006007765207RP1001X
ME015849207RP1001X
AZ37314207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME301960099Medicaid
MEH67329Medicare UPIN
AZZ118354Medicare PIN
MO965692629Medicare PIN