Provider Demographics
NPI:1689653685
Name:NACK, JAMES D (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:NACK
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:1230 E MAIN ST
Mailing Address - Street 2:PO BOX 8674
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1421 PREMIER DR
Practice Address - Street 2:MANKATO CLINIC @ WICKERSHAM CAMPUS
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56002-8674
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN467213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480018348OtherRR MEDICARE
MN115548OtherUCARE
MN2700675OtherMEDICA
MN334225500Medicaid
IA938225Medicaid
MNHP26034OtherHEALTH PARTNERS
MNNA2951014382OtherPREFERRED ONE
MN0M249NAOtherBCBA
41084933956001C040OtherCHAMPUS
MN766559OtherAMERICAS PPO
MN115548OtherUCARE
IA938225Medicaid