Provider Demographics
NPI:1306036876
Name:MUSACCHIO, MICHAEL JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:MUSACCHIO
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:KELLOGG 3RD FLOOR
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1440
Mailing Address - Fax:847-570-1442
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:KELLOGG 3RD FLOOR
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-1440
Practice Address - Fax:847-570-1442
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2021-03-11
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Provider Licenses
StateLicense IDTaxonomies
IL036112867207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery