MEDICARE: MR. MICHAEL ANDREW SASSACK LAC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	198000927	IL

General Provider Information

NPI Number	:	1013237726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANDREW SASSACK LAC.

Provider Business Mailing Address
First Line	:	303 E CAMP MCDONALD RD
Second Line	:
City	:	PROSPECT HTS
State	:	IL
Zip	:	60070-1530
Country	:	US
Telephone Number	:	847-730-7454
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 E CAMP MCDONALD RD
Second Line	:
City	:	PROSPECT HTS
State	:	IL
Zip	:	60070-1530
Country	:	US
Telephone Number	:	847-730-7454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	06/03/2010

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Directions to “ MR. MICHAEL ANDREW SASSACK LAC.” Practice Location

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