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NPI Code Detail

MEDICARE: ANDREW MACK

MEDICARE: ANDREW MACK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070-012449IL

General Provider Information

NPI Number : 1053421909
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW MACK
Provider Business Mailing Address
First Line : 900 RAND RD STE 300
Second Line :
City : DES PLAINES
State : IL
Zip : 60016-2359
Country : US
Telephone Number : 847-324-3976
Fax Number : 847-929-1154
Provider Business Practice Location Address
First Line : 20 75TH ST
Second Line :
City : WILLOWBROOK
State : IL
Zip : 60527-2325
Country : US
Telephone Number : 630-384-0600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 12/11/2024

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Directions to “ ANDREW MACK ” Practice Location

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