Individual
MR. MARIO JOSE ASTACIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
1140 N MCLEAN BLVD, SUITE C, ELGIN, IL 60123-1782
(224) 523-8971
(224) 220-0840
Mailing address
36W649 WINDING TRL, WEST DUNDEE, IL 60118-9350
(224) 558-5493
(224) 220-0840
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085-002516
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-002516
STATE PROVIDER LICENCE
IL
Enumeration date
05/16/2007
Last updated
01/20/2014
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