Healthcare Provider Details

I. General information

NPI: 1720534928
Provider Name (Legal Business Name): MSHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W WACKER DR SUITE 1320
CHICAGO IL
60606-1216
US

IV. Provider business mailing address

205 W. WACKER DR. SUITE 1320
CHICAGO IL
60606
US

V. Phone/Fax

Practice location:
  • Phone: 312-955-0512
  • Fax:
Mailing address:
  • Phone: 312-955-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAUN PASSLEY
Title or Position: PRESIDENT
Credential: PHD
Phone: 312-955-0512