Individual
DR. MOHAMED S EL-JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3003 UNIVERSITY DR STE 301, MARINETTE, WI 54143
(715) 732-8491
Mailing address
3003 UNIVERSITY DR, MARINETTE, WI 54143-4110
(715) 735-4200
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
44615
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104434930
—
MI
05
—
1538260005
—
MI
05
—
1538260005
—
WI
05
—
34272500
—
WI
Enumeration date
09/26/2006
Last updated
03/07/2023
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