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General NPI Number Information
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NPI Number | 1548265689
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Entity Type | Individual
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Provider Name | THOMAS J MACK DPM
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 6721 WEST 40TH STREET
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City | STICKNEY
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State | IL
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Zip | 60402-4171
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Country | US
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Telephone | 708-387-0633
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Fax | 708-387-0638
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Provider Business Mailing Address
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Address Line | 21041 W SNOWBERRY LN
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City | PLAINFIELD
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State | IL
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Zip | 60544-6413
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Country | US
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Telephone | 630-390-8360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016-003-689
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License Number State | IL
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