MEDICARE: MAASAL MEDICAL CENTER INC

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	207Q00000X	Family Medicine Physician	036126749	IL

General Provider Information

NPI Number	:	1235522525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAASAL MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	3462 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5117
Country	:	US
Telephone Number	:	773-654-1077
Fax Number	:	773-942-6847

Provider Business Practice Location Address
First Line	:	3462 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5117
Country	:	US
Telephone Number	:	773-654-1077
Fax Number	:	773-942-6847

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAASAL MOHAMMED SHAHER
Credential	:	M.D.
Telephone Number	:	773-654-1077

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	03/10/2015

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