| Doctor Name: | KANDICE MACK |
| NPI Number: | 1235535196 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 3101 S Gulley Rd Ste F Dearborn, MI - 481244406 |
| Business Phone Number: | 7344072500 |
| Business Fax Number: | |
| Mailing Address: | 136 William St, SPRINGFIELD |
| State: | MA |
| Postal Code: | 011052324 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2014 |
| NPI Last Update Date: | 11/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |