Individual
CASSANDRA BASAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2202 ESSINGTON RD STE 101, JOLIET, IL 60435-1604
(815) 676-5310
Mailing address
12137 HEINECKE DR, MOKENA, IL 60448-8125
(708) 638-7868
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085007029
—
IL
Enumeration date
01/19/2019
Last updated
04/08/2019
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