Provider Demographics
NPI:1013237726
Name:SASSACK, MICHAEL ANDREW (LAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:SASSACK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E CAMP MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1530
Mailing Address - Country:US
Mailing Address - Phone:847-730-7454
Mailing Address - Fax:
Practice Address - Street 1:303 E CAMP MCDONALD RD
Practice Address - Street 2:
Practice Address - City:PROSPECT HTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1530
Practice Address - Country:US
Practice Address - Phone:847-730-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000927171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist