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General NPI Number Information
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NPI Number | 1215379524
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Entity Type | Organization
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Legal Business Name | MASS MEDICAL, S.C.
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Dates
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Enumeration Date | 07/28/2013
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Last Update Date | 07/28/2013
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Provider Practice Location Address
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Address Line | 1025 W EVERETT RD SUITE 101
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City | LAKE FOREST
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State | IL
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Zip | 60045-2697
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Country | US
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Telephone | 847-234-7950
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Fax | 847-234-7940
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Provider Business Mailing Address
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Address Line | 475 MCCORMICK DR
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City | LAKE FOREST
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State | IL
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Zip | 60045-3349
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Country | US
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Telephone | 847-814-9376
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK EDWARD MASS
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Credential | M.D.
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Telephone | 847-814-9376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 042620111
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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