Individual
DAVE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1514 DRAKE ST., MADISON, WI 53711
(608) 294-9922
Mailing address
1514 DRAKE ST., MADISON, WI 53711
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
NA
WI
Other
Enumeration date
09/14/2006
Last updated
07/08/2007
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