Organization
ADVANCED CARDIOVASCULAR SERVICES
Active
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
Update your record
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