Healthcare Provider Details

I. General information

NPI: 1407813744
Provider Name (Legal Business Name): DEBORAH LYNN MACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE FL 5
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1008
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-8930
  • Fax: 317-528-8932
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01051109A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number01051109A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: