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NPI Code Detail

MEDICARE: DR. THOMAS VAL MACK MD

MEDICARE: DR. THOMAS VAL MACK MD
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
1208D00000XGeneral Practice Physician21285-20WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01529036OTHERMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417987470
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS VAL MACK MD
Provider Business Mailing Address
First Line : 3003 UNIVERSITY DR
Second Line :
City : MARINETTE
State : WI
Zip : 54143-4110
Country : US
Telephone Number : 715-735-1737
Fax Number : 715-735-1794
Provider Business Practice Location Address
First Line : 4061 OLD PESHTIGO RD
Second Line :
City : MARINETTE
State : WI
Zip : 54143-3887
Country : US
Telephone Number : 715-732-8090
Fax Number : 715-732-8015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 10/17/2018

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