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NPI Code Detail

MEDICARE: MRS. PHADI MASISI-MMUTLE

MEDICARE: MRS. PHADI MASISI-MMUTLE
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
1183500000XPharmacistIL

General Provider Information

NPI Number : 1902941248
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PHADI MASISI-MMUTLE
Provider Business Mailing Address
First Line : 6514 WALTER ADAMIC LN
Second Line :
City : PLAINFIELD
State : IL
Zip : 60586-7218
Country : US
Telephone Number : 815-436-3463
Fax Number : 815-725-7500
Provider Business Practice Location Address
First Line : 300 N OTTAWA ST
Second Line :
City : JOLIET
State : IL
Zip : 60432-4009
Country : US
Telephone Number : 815-722-3200
Fax Number : 815-725-7500
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. PHADI MASISI-MMUTLE ” Practice Location

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