Healthcare Provider Details

I. General information

NPI: 1053527747
Provider Name (Legal Business Name): MASSARO SURGICAL, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W MAIN ST
CARY IL
60013-2718
US

IV. Provider business mailing address

113 W MAIN ST
CARY IL
60013-2718
US

V. Phone/Fax

Practice location:
  • Phone: 847-639-5800
  • Fax: 847-639-2980
Mailing address:
  • Phone: 847-639-5800
  • Fax: 847-639-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES C MASSARO
Title or Position: OWNER
Credential: DPM
Phone: 847-639-5800