Organization
ADVANCED CARDIOVASCULAR SERVICES
Active
Other names
Dr. Mario Massullo
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAT DEVRIES (BILLING MANAGER)
(708) 460-5000
Entity
Organization
Contact information
Practice address
455 W. COURT ST., SUITE 202, KANKAKEE, IL 60441
(805) 936-3200
(815) 936-3203
Mailing address
PO BOX 882, KANKAKEE, IL 60901-0882
(815) 936-3200
(815) 936-3203
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004632018
BLUE CROSS
IL
05
—
036082059
—
IL
01
—
P00059541
RAILROAD MEDICARE
IL
Enumeration date
06/12/2007
Last updated
06/12/2008
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