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General NPI Number Information
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NPI Number | 1851410617
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Entity Type | Individual
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Provider Name | TERRI LYNNE MACK M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 06/19/2015
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Provider Practice Location Address
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Address Line | 400 MACK AVE
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City | DETROIT
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State | MI
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Zip | 48201-2136
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Country | US
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Telephone | 313-578-5031
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Fax | 313-578-6391
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Provider Business Mailing Address
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Address Line | 6858 PLAINVIEW ST
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City | YPSILANTI
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State | MI
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Zip | 48197-1056
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Country | US
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Telephone | 734-485-8055
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301081963
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License Number State | MI
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