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General NPI Number Information
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NPI Number | 1841764131
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Entity Type | Individual
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Provider Name | CASSANDRA BASAK
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Gender | Female
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Dates
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Enumeration Date | 01/19/2019
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 2202 ESSINGTON RD STE 101
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City | JOLIET
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State | IL
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Zip | 60435-1604
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Country | US
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Telephone | 815-676-5310
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Fax |
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Provider Business Mailing Address
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Address Line | 12137 HEINECKE DR
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City | MOKENA
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State | IL
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Zip | 60448-8125
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Country | US
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Telephone | 708-638-7868
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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