Individual
DR. THOMAS VAL MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4061 OLD PESHTIGO RD, MARINETTE, WI 54143-3887
(715) 732-8090
(715) 732-8015
Mailing address
3003 UNIVERSITY DR, MARINETTE, WI 54143-4110
(715) 735-1737
(715) 735-1794
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
21285-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30126200
—
WI
01
—
P01529036
MEDICARE RAILROAD
—
Enumeration date
07/04/2006
Last updated
10/17/2018
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