Individual
MICHAEL MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5416 N LAWRENCE ST, PHILADELPHIA, PA 19120-2804
(267) 257-9270
Mailing address
5416 N LAWRENCE ST, PHILADELPHIA, PA 19120-2804
(267) 257-9270
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
RN585234
PA
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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