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NPI Code Detail

MEDICARE: DEBORAH LYNN MACK M.D.

MEDICARE: DEBORAH LYNN MACK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician01051109AIN
22080H0002XPediatric Hospice and Palliative Medicine Physician01051109AIN

General Provider Information

NPI Number : 1407813744
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH LYNN MACK M.D.
Provider Business Mailing Address
First Line : 236 EVERGREEN DR
Second Line :
City : BATESVILLE
State : IN
Zip : 47006-5161
Country : US
Telephone Number : 812-934-4074
Fax Number :
Provider Business Practice Location Address
First Line : 720 ESKENAZI AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5187
Country : US
Telephone Number : 317-278-5316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2006
Last Update Date : 04/25/2025

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