Individual
KEVIN GERARD MASTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1335 N MILL ST STE 100, NAPERVILLE, IL 60563-2047
(847) 982-6710
Mailing address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01078057A
IN
2084P0800X
Psychiatry Physician
Primary
036165554
IL
2084P0802X
Addiction Psychiatry Physician
036165554
IL
390200000X
Student in an Organized Health Care Education/Training Program
11018125A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201295060
—
IN
Enumeration date
05/19/2015
Last updated
05/30/2024
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