# HYDE PARK MEDICAL SPECIALTY GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588656037
- **Authorized official:** MRS. FORTUNEE MASSUDA DPM (MEDICAL DIRECTOR/CEO)
- **Authorized official phone:** (773) 752-2111

## Contact information

- **Practice address:** 1644 E 53RD ST, CHICAGO, IL 60615-4210
- **Practice address phone:** (773) 752-2111
- **Practice address fax:** (773) 752-6703
- **Mailing address:** 9933 S WESTERN AVE, SUITE 102, CHICAGO, IL 60643-1810
- **Mailing address phone:** (773) 233-3800
- **Mailing address fax:** (773) 233-2513

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | IL | — |

## Other

- **Enumeration date:** 08/19/2005
- **Last updated:** 07/19/2012