Provider Demographics
NPI:1821283284
Name:MASON, JAMES MICHAEL (RSA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:MASON
Suffix:
Gender:M
Credentials:RSA
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 636
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-0636
Mailing Address - Country:US
Mailing Address - Phone:630-378-3114
Mailing Address - Fax:
Practice Address - Street 1:14855 S. VAN DYKE RD
Practice Address - Street 2:SUITE 636
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-4326
Practice Address - Country:US
Practice Address - Phone:630-378-3114
Practice Address - Fax:630-378-3118
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000031246ZC0007X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL238000031OtherSTATE LICENSE