Individual
MICHAEL A WACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
46 FAIRVIEW AVE STE 113, SKOWHEGAN, ME 04976-1481
(207) 474-3697
(207) 474-6355
Mailing address
PO BOX 468, SKOWHEGAN, ME 04976-0468
(207) 474-3697
(207) 474-6355
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
151740
MA
207X00000X
Orthopaedic Surgery Physician
Primary
MD26916
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3157733
—
MA
Enumeration date
12/02/2005
Last updated
07/03/2023
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