Individual
ROBERT B MACNACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
515 22ND AVE, MONROE, WI 53566-1569
(608) 324-2000
(405) 769-9689
Mailing address
515 22ND AVE, MONROE, WI 53566-1569
(608) 324-2000
(405) 769-9689
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
28991
OK
207Q00000X
Family Medicine Physician
Primary
69016-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200438910A
—
OK
01
—
28991
OK LICENSE
OK
01
—
P01243530
MEDICARE RAILROAD
OK
Enumeration date
08/12/2009
Last updated
12/31/2020
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