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General NPI Number Information
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NPI Number | 1821315128
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Entity Type | Organization
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Legal Business Name | WESTSIDE RHEUMATOLOGY, INC.
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 2875 W 19TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-3501
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Country | US
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Telephone | 773-983-5785
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Fax | 708-423-9666
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Provider Business Mailing Address
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Address Line | 9449 S KEDZIE AVE SUITE 317
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2325
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Country | US
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Telephone | 773-983-5785
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Fax | 708-423-9666
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DONALD MASSENBURG
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Credential | M.D.
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Telephone | 773-983-5785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 036115006
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License Number State | IL
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