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General NPI Number Information
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NPI Number | 1669419412
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Entity Type | Individual
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Provider Name | BRUCE JONATHAN MASSEL MD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 9977 WOODS DR STE 100
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City | SKOKIE
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State | IL
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Zip | 60077-1057
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Country | US
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Telephone | 847-663-8350
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Fax | 847-933-3595
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Provider Business Mailing Address
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Address Line | 2650 RIDGE AVE STE 1223
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City | EVANSTON
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State | IL
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Zip | 60201-1700
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Country | US
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Telephone | 847-570-2040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-070349
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License Number State | IL
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