Provider Demographics
NPI:1215076617
Name:MACKLER, JEFFREY M (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:MACKLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 W BOUGHTON RD
Mailing Address - Street 2:SUITE A JEFFREY M MACKLER DPM
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1378
Mailing Address - Country:US
Mailing Address - Phone:630-759-4411
Mailing Address - Fax:630-759-6063
Practice Address - Street 1:454 W BOUGHTON RD
Practice Address - Street 2:SUITE A JEFFREY M MACKLER DPM
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1378
Practice Address - Country:US
Practice Address - Phone:630-759-4411
Practice Address - Fax:630-759-6063
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T36171Medicare UPIN
IN0897740001Medicare NSC