Provider Demographics
NPI:1720126675
Name:DEMASK FAMILY MEDICAL S.C.
Entity Type:Organization
Organization Name:DEMASK FAMILY MEDICAL S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMASK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-467-5100
Mailing Address - Street 1:201 S WABENA AVE
Mailing Address - Street 2:SUITE LL-A
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-8723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 S WABENA AVE
Practice Address - Street 2:SUITE LL-A
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-8723
Practice Address - Country:US
Practice Address - Phone:815-467-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care