Organization
MARK SACK DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SACK DPM (PRESIDENT)
(773) 238-7270
Entity
Organization
Contact information
Practice address
3216 W 115TH ST, CHICAGO, IL 60655-2805
(773) 238-7270
(773) 238-9627
Mailing address
PO BOX 1262, NORTHBROOK, IL 60065-1262
(773) 238-7270
(773) 238-9627
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633481
BCBS
IL
01
—
DE0221
RAILROAD MEDICARE
IL
Enumeration date
07/09/2006
Last updated
05/22/2020
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