Individual
MICHAEL R FASSL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11600 S KEDZIE AVE, MERRIONETTE PARK, IL 60803-6307
(708) 272-4150
(708) 229-0696
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-165936
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-165936
LICENSE
IL
Enumeration date
04/17/2020
Last updated
10/11/2023
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