Healthcare Provider Details

I. General information

NPI: 1811488646
Provider Name (Legal Business Name): JOHN FOX MAST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE
AURORA IL
60504-5893
US

IV. Provider business mailing address

2000 OGDEN AVE STE P050
AURORA IL
60504-5893
US

V. Phone/Fax

Practice location:
  • Phone: 866-565-8607
  • Fax: 312-563-8661
Mailing address:
  • Phone: 630-499-2404
  • Fax: 630-499-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036156608
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036156608
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125072449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: