Provider Demographics
NPI:1013916485
Name:MASOOD, PERNIYA (MD)
Entity type:Individual
Prefix:
First Name:PERNIYA
Middle Name:
Last Name:MASOOD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 BRIARGATE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2225
Mailing Address - Country:US
Mailing Address - Phone:847-717-6400
Mailing Address - Fax:847-717-0500
Practice Address - Street 1:472 BRIARGATE DR
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2225
Practice Address - Country:US
Practice Address - Phone:847-717-6400
Practice Address - Fax:847-717-0500
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532205OtherBLUE CROSS BLUE SHIELD
IL04532205OtherBLUE CROSS BLUE SHIELD