Mack, Todd M

Mack, Todd M is an individual health care provider with primary practice located at 18 Chicago Ave , Oak Park IL 60302. 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, Todd M can be contacted via phone (773) 253-3933.

Contact Information

Primary practice address
18 Chicago Ave Oak Park IL 60302
Phone: (773) 253-3933
Fax: (773) 437-6780
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 892-025 Wisconsin
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 016005154 Illinois
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 5325 California

Profile Details

NPI number 1114039369
LBN Legal business name Mack, Todd M
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Nov 18th, 2019 - about 5 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 1114039369 NPPES
Illinois MEDICAID 016005154
Illinois MEDICAID 43267600
Illinois Other 01634612
Illinois MEDICAID 43237200

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