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Individual
MR. GREGG JON MACEK
Active
Individual
MR. GREGG JON MACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096-000773
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096.000773
STATE LICENSE NUMBER
IL
01
—
099502478
BOARD OF CERTIFICATION NUMBER
IL
Enumeration date
11/30/2005
Last updated
05/19/2011
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