Individual
MR. MARTY PHILLIP DACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1703 E MICHIGAN AVE, LANSING, MI 48912-2841
(517) 913-3860
(517) 484-6864
Mailing address
1703 E MICHIGAN AVE, LANSING, MI 48912-2841
(517) 913-3860
(517) 484-6864
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704222015
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1057822
MCLAREN HEALTH PLAN-COMMERCIAL
MI
01
—
200000006547
PHP FAMILYCARE
MI
05
—
4950304
—
MI
01
—
5008702500
BLUE CROSS BLUE SHILED
MI
01
—
7952506
AETNA
MI
01
—
N55170013
MEDICARE PLUS BLUE
MI
01
—
P00367059
RAILROAD MEDICARE
MI
Enumeration date
10/02/2006
Last updated
08/26/2010
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