Healthcare Provider Details

I. General information

NPI: 1528282761
Provider Name (Legal Business Name): MACK FOOT & ANKLE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 ROSE ST
FRANKLIN PARK IL
60131-2928
US

IV. Provider business mailing address

2821 ROSE ST
FRANKLIN PARK IL
60131-2928
US

V. Phone/Fax

Practice location:
  • Phone: 847-455-5233
  • Fax: 847-455-5086
Mailing address:
  • Phone: 847-455-5233
  • Fax: 847-455-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005154
License Number StateIL

VIII. Authorized Official

Name: DR. TODD M MACK
Title or Position: PRESIDENT
Credential: DPM
Phone: 847-455-5233