=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346212461
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH L MASTRO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2006
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 N 2ND ST
-----------------------------------------------------
City | ROCHELLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61068-1764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-562-2181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 654 S HILLSIDE AVE
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-4247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-279-5517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 036093835
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------