Provider Demographics
NPI:1811254568
Name:MASRUR, MARIO ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ALBERTO
Last Name:MASRUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:STE 435E - MC 958
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-355-1493
Mailing Address - Fax:
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:3F - OCC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-996-6883
Practice Address - Fax:312-355-6337
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2015-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036136813208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery