DR. THOMAS VAL MACK (NPI# 1417987470) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417987470 |
| Entity Type | Individual |
| Full Name | DR. THOMAS VAL MACK |
| Credential | MD |
| Practice Address |
4061 Old Peshtigo Rd Marinette WI 54143-3887 |
| Mailing Address |
3003 University Dr Marinette WI 54143-4110 |
| Practice Telephone | 7157328090 |
| Practice Fax Number | 7157328015 |
| Mailing Telephone | 7157351737 |
| Mailing Fax Number | 7157351794 |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2018-10-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 21285-20 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE RAILROAD | P01529036 | 01 | |
| WI | 30126200 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750422853 | Thomas Patrick Mack | Dentist | 63 Bay Tree Ln, Los Altos, CA 94022-4624 | 2007-02-09 |
| 1689644726 | Thomas C Mack | Chiropractor | 116 W Smith St, Corry, PA 16407-1558 | 2006-01-23 |
| 1548265689 | Thomas J Mack | Podiatrist | 6721 West 40th Street, Stickney, IL 60402-4171 | 2005-06-16 |
| 1881251783 | Thomas Criswell Mack | Psychologist | 421 E Market St, Iowa City, IA 52245-2628 | 2019-05-26 |
| 1508129362 | Thomas Mack | Social Worker | 528 N Main St, Providence, RI 02904-5757 | 2012-06-18 |
| 1386912129 | Thomas Mcculloch Mack | Internal Medicine | 1441 Eastlake Ave, Rm 4453, Los Angeles, CA 90089-0112 | 2011-12-08 |
| 1770897167 | Thomas Gerard Mack | Case Manager/Care Coordinator | 1430 Olive St, Suite 500, Saint Louis, MO 63103-2303 | 2010-07-28 |
| 1396817060 | Thomas A Mack | Optometrist | 7701 Frontage Rd, Suite A, Overland Park, KS 66204-2364 | 2006-11-15 |
| 1659474013 | Thomas Michael Mack | Dentist | 17215 N 72nd Dr, Ste A100, Glendale, AZ 85308 | 2006-09-07 |
| Street Address |
4061 OLD PESHTIGO RD |
| City | MARINETTE |
| State | WI |
| Zip Code | 54143-3887 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568467850 | Vickie Marie Cloutier | Family Medicine | 4061 Old Peshtigo Rd, Marinette, WI 54143-3887 | 2005-06-15 |
| 1669008488 | Karin Beal | Social Worker | 4061 Old Peshtigo Rd, Marinette, WI 54143-3887 | 2020-03-13 |
| 1841844305 | Ashley Jones | Nurse Practitioner | 4061 Old Peshtigo Rd, Marinette, WI 54143-3887 | 2019-08-01 |
| 1710403324 | Ramona S Klevgard | Nurse Practitioner | 4061 Old Peshtigo Rd, Marinette, WI 54143-3887 | 2017-08-15 |
| 1295259596 | Cody A Pangrazzi | Social Worker | 4061 Old Peshtigo Rd, Marinette, WI 54143-3887 | 2017-07-28 |
| 1851759146 | Aurora Bay Area Medical Group, LLC | Durable Medical Equipment & Medical Supplies | 4061 Old Peshtigo Rd, Marinette, WI 54143-3887 | 2016-02-02 |
| 1629474721 | Khaled Elkady Hussein | Internal Medicine | 4061 Old Peshtigo Rd, Aurora Health Center, Marinette, WI 54143-3887 | 2014-11-17 |
| 1497190904 | Michelle L Shallow | Physical Therapy Assistant | 4061 Old Peshtigo Rd, Marinette, WI 54143-3887 | 2013-05-10 |
| 1376886614 | Tolulope Olakunle Abikoye | Family Medicine | 4061 Old Peshtigo Rd, Marinette, WI 54143-3887 | 2013-04-05 |
| 1780928846 | Natalie Ann Oberdorfer | Pharmacist | 4061 Old Peshtigo Rd, Marinette, WI 54143-3887 | 2012-11-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669966750 | Allie Parthie | Dentist | 1420 University Dr, Marinette, WI 54143 | 2018-06-21 |
| 1043730690 | Jonathan Weseman | Emergency Medicine | 3003 University Dr, Marinette, Marinette, WI 54143 | 2017-06-25 |
| 1538698618 | Meghan M Russell | Nurse Practitioner | 4061 Old Peshtigo Road, Marinette, WI 54143 | 2017-06-12 |
| 1801279435 | Stephanie Miller | Licensed Practical Nurse | W1902 State Hwy 64, Marinette, WI 54143 | 2015-07-01 |
| 1417298704 | Danielle Risner | Occupational Therapist | Luther Home 831 Pine Beach Rd, Marinette, WI 54143 | 2013-03-12 |
| 1053631903 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | W 716 County B, Ste B, Marinette, WI 54143 | 2010-06-02 |
| 1417105545 | Forefront Dermatology, S.c. | Dermatology | 3515 Murray Street, Marinette, WI 54143 | 2008-09-03 |
| 1245493352 | Judith M Ribbens | Counselor | 1557 Cleveland Ave, Marinette, WI 54143 | 2008-07-08 |
| 1538338926 | Charlene Mae Miller | Licensed Practical Nurse | 1126 Daggett, Marinette, WI 54143 | 2008-02-29 |
| 1104025519 | James Alan Boren | Family Medicine | 5926 Highway 41, Stephenson, MI 54143 | 2007-07-16 |
| Find all providers in zip 54143 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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|---|---|---|---|---|
| 1104458025 | Lisa M Bender | General Practice | 213 Bergamont Blvd Apt 101, Oregon, WI 53575-3722 | 2020-02-08 |
| 1093368607 | New Medical Center, S.c. | General Practice | 160 Gateway Dr, Ste A, Waupun, WI 53963-2276 | 2019-07-23 |
| 1760946628 | Amie Jabang | General Practice | 534 Aztalan Dr, Madison, WI 53718-3205 | 2019-01-24 |
| 1750866828 | Fi-med Management Inc | General Practice | 333 Bishops Way Ste 122, Brookfield, WI 53005-6209 | 2018-09-25 |
| 1073017265 | Vincent Lucas David Fryer | General Practice | 2329 Sunny Ln Apt C, Suamico, WI 54313-7821 | 2018-03-21 |
| 1952846982 | Practice Partners Healthcare Group, S.c. | General Practice | 1434 Thelen Farm Trl, Houlton, WI 54082-2062 | 2016-12-29 |
| 1649647462 | Astia Health Clinical Services, Sc | General Practice | 630 S Central Ave Ste 303, Marshfield, WI 54449-4196 | 2015-08-27 |
| 1306237417 | Aaron Rosenberg | General Practice | 1516 W Mequon Rd Ste 103, Mequon, WI 53092-3264 | 2015-02-10 |
| 1255693347 | Robin Louise Chene | General Practice | 530 W Lakeside St, Madison, WI 53715-1728 | 2012-06-13 |
| 1780951095 | Erwin Fredrick Koenig I | General Practice | 825 Charing Cross Rd, Madison, WI 53704-6082 | 2011-11-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.