Provider Demographics
NPI:1801966999
Name:MASSEY, PATRICK B (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:B
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 NERGE RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3673
Mailing Address - Country:US
Mailing Address - Phone:847-923-0046
Mailing Address - Fax:847-923-0047
Practice Address - Street 1:1544 NERGE RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3673
Practice Address - Country:US
Practice Address - Phone:847-923-0046
Practice Address - Fax:847-923-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 208100000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635922OtherBLUE CROSS BLUE SHIELD
IL214753Medicare PIN
ILE24679Medicare UPIN
IL01635922OtherBLUE CROSS BLUE SHIELD