Provider Demographics
NPI:1184679466
Name:MASTER MEDICAL CARE LLC
Entity Type:Organization
Organization Name:MASTER MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-397-2750
Mailing Address - Street 1:10 EMERALD TER
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2310
Mailing Address - Country:US
Mailing Address - Phone:618-235-6780
Mailing Address - Fax:618-235-6740
Practice Address - Street 1:10 EMERALD TER
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2310
Practice Address - Country:US
Practice Address - Phone:618-235-6780
Practice Address - Fax:618-235-6740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty