Individual
CARL TACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 36TH ST, VERO BEACH, FL 32960-4862
(772) 563-4711
Mailing address
22 GATEWAY LN, MANORVILLE, NY 11949-2527
(718) 612-6662
(631) 878-6021
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
122629
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01225323
—
NY
05
—
200093473
—
MO
Enumeration date
11/13/2006
Last updated
11/03/2025
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