MEDICARE: MARY F HACKER 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
1	208D00000X	General Practice Physician	18164	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17705	OTHER	IA	WELLMARK BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568459188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY F HACKER MD

Provider Business Mailing Address
First Line	:	4189 WESTLAWN S
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1100
Country	:	US
Telephone Number	:	319-335-8370
Fax Number	:	314-335-7247

Provider Business Practice Location Address
First Line	:	4189 WESTLAWN S
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1100
Country	:	US
Telephone Number	:	319-335-8370
Fax Number	:	314-335-7247

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/08/2007

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Directions to “ MARY F HACKER MD” Practice Location

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