MEDICARE: PERNIYA MASOOD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036087296	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04532205	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1013916485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERNIYA MASOOD M.D.

Provider Business Mailing Address
First Line	:	472 BRIARGATE DR
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-2225
Country	:	US
Telephone Number	:	847-717-6400
Fax Number	:	847-717-0500

Provider Business Practice Location Address
First Line	:	472 BRIARGATE DR
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-2225
Country	:	US
Telephone Number	:	847-717-6400
Fax Number	:	847-717-0500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/24/2025

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