MEDICARE: MARK SACK DPM

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	016005080	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00267009	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1548286313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK SACK DPM

Provider Business Mailing Address
First Line	:	3216 W 115TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2805
Country	:	US
Telephone Number	:	773-238-7270
Fax Number	:	773-238-9627

Provider Business Practice Location Address
First Line	:	3216 W 115TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2805
Country	:	US
Telephone Number	:	773-238-7270
Fax Number	:	773-238-9627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/16/2014

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Directions to “ MARK SACK DPM” Practice Location

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