Provider Demographics
NPI:1053481911
Name:HASS, MARSIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSIE
Middle Name:R
Last Name:HASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17850 S. KEDZIE AVE
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2086
Mailing Address - Country:US
Mailing Address - Phone:708-798-2400
Mailing Address - Fax:
Practice Address - Street 1:17850 S KEDZIE AVENUE
Practice Address - Street 2:SUITE 3100
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2086
Practice Address - Country:US
Practice Address - Phone:708-798-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067945Medicaid
ILD16268Medicare UPIN