NPI 1376648154

Dave Mack

Practitioner Military Health Care Provider Madison, WI

Practice location

Address: 1514 Drake St., Madison, WI 53711
Phone: (608) 294-9922

Registered specialties

Military Health Care Provider Primary

Other Service Providers Taxonomy 171000000X Licence NA (WI)

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Registry record

NPI: 1376648154
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Sep 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.