MEDICARE: MARK SACK DPM PC

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DE0221	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01633481	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1902839194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK SACK DPM PC

Provider Business Mailing Address
First Line	:	PO BOX 1262
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60065-1262
Country	:	US
Telephone Number	:	773-238-7270
Fax Number	:	773-238-9627

Provider Business Practice Location Address
First Line	:	3216 W 115TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2805
Country	:	US
Telephone Number	:	773-238-7270
Fax Number	:	773-238-9627

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK SACK
Credential	:	DPM
Telephone Number	:	773-238-7270

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	05/22/2020

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Directions to “MARK SACK DPM PC ” Practice Location

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