Healthcare Provider Details

I. General information

NPI: 1881348431
Provider Name (Legal Business Name): DR. MASHARY BINNAHIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

5500 NORTH ST
NACOGDOCHES TX
75965-1372
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4056
  • Fax:
Mailing address:
  • Phone: 936-560-6999
  • Fax: 936-560-9139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036165904
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberT1905
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: