Massullo, Mario Gerard
Massullo, Mario Gerard is an sole proprietor health care provider with primary practice located at 1710 W. Court St. , Kankakee IL 60901. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Interventional Cardiology, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Cardiovascular Disease is his primary health care specialty. Massullo, Mario Gerard can be contacted via phone (815) 936-3200.Contact Information
Primary practice address
1710 W. Court St.
Kankakee IL 60901
Phone: (815) 936-3200
Fax: (815) 936-3203
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 036082059 | Illinois |
| Allopathic & Osteopathic Physicians / Interventional Cardiology | 207RI0011X | 036082059 | Illinois |
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 036082059 | Illinois |
Profile Details
| NPI number | 1043228158 |
|---|---|
| LBN Legal business name | Massullo, Mario Gerard |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 4th, 2006 |
| Last updated | Oct 27th, 2021 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043228158 | NPPES |
| Illinois | MEDICAID | 036082059 |
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