Provider Demographics
NPI:1457310757
Name:MACK, JAMES C II (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:MACK
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2351 HUGUENARD DR
Mailing Address - Street 2:STUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-260-7700
Mailing Address - Fax:859-260-7797
Practice Address - Street 1:2351 HUGUENARD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-260-7700
Practice Address - Fax:859-260-7797
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY19608208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64196082Medicaid