Provider Demographics
NPI:1053527747
Name:MASSARO SURGICAL, LTD
Entity type:Organization
Organization Name:MASSARO SURGICAL, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MASSARO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-639-5800
Mailing Address - Street 1:113 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2718
Mailing Address - Country:US
Mailing Address - Phone:847-639-5800
Mailing Address - Fax:847-639-2980
Practice Address - Street 1:113 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2718
Practice Address - Country:US
Practice Address - Phone:847-639-5800
Practice Address - Fax:847-639-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical