Astacio, Mario Jose

Astacio, Mario Jose is an sole proprietor health care provider with primary practice located at 1140 N Mclean Blvd Suite C, Elgin IL 60123-1782. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Astacio, Mario Jose can be contacted via phone (224) 523-8971.

Contact Information

Primary practice address
1140 N Mclean Blvd Suite C Elgin IL 60123-1782
Phone: (224) 523-8971
Fax: (224) 220-0840
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 085-002516 Illinois

Profile Details

NPI number 1508073198
LBN Legal business name Astacio, Mario Jose
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 16th, 2007
Last updated Jan 20th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508073198 NPPES
Illinois Other 085-002516 STATE PROVIDER LICENCE

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