Mack, Gregory J

Mack, Gregory J is an individual health care provider with primary practice located at 201 Cedar Falls Rd , Menomonie WI 54751-1270. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Mack, Gregory J can be contacted via phone (715) 235-4274.

Contact Information

Primary practice address
201 Cedar Falls Rd Menomonie WI 54751-1270
Phone: (715) 235-4274
Fax: (715) 235-9644
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 651025 Wisconsin

Profile Details

NPI number 1760577506
LBN Legal business name Mack, Gregory J
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2006
Last updated Jan 27th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760577506 NPPES
Wisconsin MEDICAID 43214300

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