| Doctor Name: | DR. BRUCE JAMES MACK |
| NPI Number: | 1013958339 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 40493 |
| Business Practice Address: | 4225 Golden Valley Rd Golden Valley, MN - 554224215 |
| Business Phone Number: | 7635880661 |
| Business Fax Number: | 7632872310 |
| Mailing Address: | 4225 Golden Valley Rd, GOLDEN VALLEY |
| State: | MN |
| Postal Code: | 554224215 |
| Phone Number: | 7635880661 |
| Fax Number: | 7632872310 |
| NPI Enumeration Date: | 06/09/2006 |
| NPI Last Update Date: | 07/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084N0400X |
| License Number: | 40493 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Neurology |
| Taxonomy Definition: | A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |