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Organization
HYDE PARK MEDICAL SPECIALTY GROUP, LLC
Active
Organization
HYDE PARK MEDICAL SPECIALTY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FORTUNEE MASSUDA DPM (MEDICAL DIRECTOR/CEO)
(773) 752-2111
Entity
Organization
Contact information
Practice address
1644 E 53RD ST, CHICAGO, IL 60615-4210
(773) 752-2111
(773) 752-6703
Mailing address
9933 S WESTERN AVE, SUITE 102, CHICAGO, IL 60643-1810
(773) 233-3800
(773) 233-2513
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
IL
Other
Enumeration date
08/19/2005
Last updated
07/19/2012
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