Doctor Name: | DR. TODD M MACK |
NPI Number: | 1114039369 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.P.M. |
License Number: | 892-025 |
Business Practice Address: | 2821 Rose St Franklin Park, IL - 601312928 |
Business Phone Number: | 8474555233 |
Business Fax Number: | 8474555086 |
Mailing Address: | 2821 Rose St, FRANKLIN PARK |
State: | IL |
Postal Code: | 601312928 |
Phone Number: | 8474555233 |
Fax Number: | 8474555086 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 08/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 892-025 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |