Healthcare Provider Details

I. General information

NPI: 1093748394
Provider Name (Legal Business Name): NAJAH SENNO MUSACCHIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAJAH SENNO M.D.

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DODGE AVE RM H-101
EVANSTON IL
60201-3449
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-424-7265
  • Fax: 847-492-5809
Mailing address:
  • Phone: 847-982-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-113660
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: