MEDICARE: TERRY MASON MD

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	208800000X	Urology Physician	036059147	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01621679	OTHER	IL	BCBS OF IL

General Provider Information

NPI Number	:	1205813094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY MASON MD

Provider Business Mailing Address
First Line	:	2850 S WABASH AVE
Second Line	:	SUITE 106
City	:	CHICAGO
State	:	IL
Zip	:	60616-2955
Country	:	US
Telephone Number	:	312-842-4400
Fax Number	:	312-842-4595

Provider Business Practice Location Address
First Line	:	2850 S WABASH AVE
Second Line	:	SUITE 106
City	:	CHICAGO
State	:	IL
Zip	:	60616-2955
Country	:	US
Telephone Number	:	312-842-4400
Fax Number	:	312-842-4595

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	04/20/2010

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Directions to “ TERRY MASON MD” Practice Location

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