Individual
DR. THOMAS J MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
6721 WEST 40TH STREET, STICKNEY, IL 60402-4171
(708) 387-0633
(708) 387-0638
Mailing address
21041 W SNOWBERRY LN, PLAINFIELD, IL 60544-6413
(630) 390-8360
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016-003-689
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003689
—
IL
Enumeration date
06/16/2005
Last updated
04/29/2020
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