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General NPI Number Information
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NPI Number | 1750523452
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Entity Type | Organization
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Legal Business Name | JOSEPH MAZZEI, S.C.
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 65 E WACKER PL SUITE 600
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City | CHICAGO
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State | IL
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Zip | 60601-7296
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Country | US
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Telephone | 866-962-5689
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Fax | 866-962-6357
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Provider Business Mailing Address
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Address Line | 2217 N OAKLEY AVE 1S
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City | CHICAGO
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State | IL
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Zip | 60647-6350
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Country | US
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Telephone | 866-962-5689
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Fax | 866-962-6357
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOSEPH MAZZEI
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Credential | D.O.
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Telephone | 866-962-5689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036106115
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License Number State | IL
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