MEDICARE: MAREK KACKI M.D.

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	207RN0300X	Nephrology Physician	24672	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932191921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAREK KACKI M.D.

Provider Business Mailing Address
First Line	:	28 WHITE BRIDGE RD
Second Line	:	STE. 300
City	:	NASHVILLE
State	:	TN
Zip	:	37205-1499
Country	:	US
Telephone Number	:	615-356-4111
Fax Number	:	615-356-8011

Provider Business Practice Location Address
First Line	:	1401 HATCHER LN
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3535
Country	:	US
Telephone Number	:	931-388-3209
Fax Number	:	931-388-0105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	02/04/2009

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