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General NPI Number Information
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NPI Number | 1841276847
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Entity Type | Individual
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Provider Name | MARK E MASS MD
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Gender | Male
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 04/23/2014
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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 | 847-234-7940
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 36093222
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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 | 036-093222
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 036-093222
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036-093222
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 036-093222
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License Number State | IL
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