Angela E Mack, RD | |
2000 Lake Ave, Woodstock, IL 60098-7401 | |
(815) 337-7100 | |
Not Available |
Full Name | Angela E Mack |
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Gender | Female |
Speciality | Dietitian, Registered |
Location | 2000 Lake Ave, Woodstock, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1902991078 | NPI | - | NPPES |
1794-029 | Other | WI | LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 1794-029 (Wisconsin) | Secondary |
133V00000X | Dietitian, Registered | (Illinois) | Primary |
Provider Name | Mercy Health System Corporation |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1598718603 PECOS PAC ID: 7416860440 Enrollment ID: O20031111000307 |
Mailing Address | Practice Location Address |
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Angela E Mack, RD 2000 Lake Ave, Woodstock, IL 60098-7401 Ph: (815) 337-7100 | Angela E Mack, RD 2000 Lake Ave, Woodstock, IL 60098-7401 Ph: (815) 337-7100 |
Jesell Zepeda, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 905 Hickory Rd, Woodstock, IL 60098 Phone: 815-670-4717 | |
Stacia Riffe, MS,RD,LDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2125 Greenview Dr, Woodstock, IL 60098 Phone: 815-355-8237 | |
Mary Jo Winkenwerder, RD, LD Dietitian Medicare: Medicare Enrolled Practice Location: 2000 Lake Ave, Woodstock, IL 60098 Phone: 815-337-7100 Fax: 815-337-4793 | |
Jacob Miceli, Dietitian Medicare: Not Enrolled in Medicare Practice Location: 907 Powers Rd, Woodstock, IL 60098 Phone: 815-276-9457 | |
Mrs. Tiffanie Ann Young, MS, RD, LDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 3701 Doty Road, Centegra Hospital - Woodstock, Woodstock, IL 60098 Phone: 815-334-3113 Fax: 815-334-3941 |