Organization
MACK FOOT & ANKLE, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD M MACK DPM (PRESIDENT)
(847) 455-5233
Entity
Organization
Contact information
Practice address
2821 ROSE ST, FRANKLIN PARK, IL 60131-2928
(847) 455-5233
(847) 455-5086
Mailing address
2821 ROSE ST, FRANKLIN PARK, IL 60131-2928
(847) 455-5233
(847) 455-5086
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005154
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016005154
—
IL
01
—
01634612
BLUE CROSS BLUE SHIELD
IL
05
—
43267600
—
WI
Enumeration date
04/12/2007
Last updated
08/14/2008
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