Healthcare Provider Details

I. General information

NPI: 1215379524
Provider Name (Legal Business Name): MASS MEDICAL, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2013
Last Update Date: 07/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W EVERETT RD SUITE 101
LAKE FOREST IL
60045-2697
US

IV. Provider business mailing address

475 MCCORMICK DR
LAKE FOREST IL
60045-3349
US

V. Phone/Fax

Practice location:
  • Phone: 847-234-7950
  • Fax: 847-234-7940
Mailing address:
  • Phone: 847-814-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number042620111
License Number StateIL

VIII. Authorized Official

Name: DR. MARK EDWARD MASS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-814-9376