Provider Demographics
NPI:1750523452
Name:JOSEPH MAZZEI, S.C.
Entity type:Organization
Organization Name:JOSEPH MAZZEI, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZEI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:866-962-5689
Mailing Address - Street 1:2217 N OAKLEY AVE
Mailing Address - Street 2:1S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6350
Mailing Address - Country:US
Mailing Address - Phone:866-962-5689
Mailing Address - Fax:866-962-6357
Practice Address - Street 1:65 E WACKER PL
Practice Address - Street 2:SUITE 600
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7296
Practice Address - Country:US
Practice Address - Phone:866-962-5689
Practice Address - Fax:866-962-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106115174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty