Provider Demographics
NPI:1619292224
Name:HOWARD M HACK MD-NEVADA PC
Entity Type:Organization
Organization Name:HOWARD M HACK MD-NEVADA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:HACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-975-1255
Mailing Address - Street 1:8413 W LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7638
Mailing Address - Country:US
Mailing Address - Phone:702-247-6401
Mailing Address - Fax:702-247-6402
Practice Address - Street 1:8413 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7638
Practice Address - Country:US
Practice Address - Phone:702-247-6401
Practice Address - Fax:702-247-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12717174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty