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NPI Code Detail

MEDICARE: MR. GREGG JON MACEK ATC

MEDICARE: MR. GREGG JON MACEK ATC
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
12255A2300XAthletic Trainer096-000773IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1096.000773OTHERILSTATE LICENSE NUMBER
2099502478OTHERILBOARD OF CERTIFICATION NUMBER

General Provider Information

NPI Number : 1740264159
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GREGG JON MACEK ATC
Provider Business Mailing Address
First Line : 929 W HIGGINS RD
Second Line :
City : SCHAUMBURG
State : IL
Zip : 60195-3203
Country : US
Telephone Number : 847-285-4385
Fax Number : 847-285-4240
Provider Business Practice Location Address
First Line : 929 W HIGGINS RD
Second Line :
City : SCHAUMBURG
State : IL
Zip : 60195-3203
Country : US
Telephone Number : 847-285-4385
Fax Number : 847-285-4240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 05/19/2011

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