Healthcare Provider Details

I. General information

NPI: 1255451563
Provider Name (Legal Business Name): ROBERT J S MACK, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W HIGGINS RD STE 102
HOFFMAN EST IL
60169-4033
US

IV. Provider business mailing address

1220 W HIGGINS RD STE 102
HOFFMAN EST IL
60169-4033
US

V. Phone/Fax

Practice location:
  • Phone: 847-755-9393
  • Fax: 847-755-1560
Mailing address:
  • Phone: 847-755-9393
  • Fax: 847-755-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT J MACK
Title or Position: PRESIDENT
Credential: MD
Phone: 847-755-9393