Healthcare Provider Details

I. General information

NPI: 1144751249
Provider Name (Legal Business Name): DUSTIN HEATH MASSEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 GROSS POINT RD STE 1200
SKOKIE IL
60076-1214
US

IV. Provider business mailing address

9600 GROSS POINT RD STE 1200
SKOKIE IL
60076-1214
US

V. Phone/Fax

Practice location:
  • Phone: 847-982-3171
  • Fax:
Mailing address:
  • Phone: 847-982-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number036.160320
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: