Provider Demographics
NPI:1073597142
Name:MASUTTI, VERA HELENA (DO)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:HELENA
Last Name:MASUTTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87904
Mailing Address - Street 2:DEPT 2049
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188
Mailing Address - Country:US
Mailing Address - Phone:630-734-0200
Mailing Address - Fax:630-734-1560
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:ALEXIAN BROTHERS MEDICAL CENTER
Practice Address - City:ELK GROVE
Practice Address - State:IL
Practice Address - Zip Code:60007
Practice Address - Country:US
Practice Address - Phone:847-437-5500
Practice Address - Fax:630-734-1560
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003618A207P00000X
IL036083100207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083100Medicaid
E93148Medicare UPIN