Individual
GREGORY J MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
201 CEDAR FALLS RD, MENOMONIE, WI 54751-1270
(715) 235-4274
(715) 235-9644
Mailing address
PO BOX 392, MENOMONIE, WI 54751-0392
(715) 235-4274
(715) 235-9644
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
651025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43214300
—
WI
Enumeration date
10/04/2006
Last updated
01/27/2022
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