Provider Demographics
NPI:1912078759
Name:MASNYK, TARAS (MD, PHD)
Entity Type:Individual
Prefix:
First Name:TARAS
Middle Name:
Last Name:MASNYK
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 1:25 N WINFIELD RD
Mailing Address - Street 2:ASP #500
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1222
Mailing Address - Country:US
Mailing Address - Phone:630-933-4056
Mailing Address - Fax:630-933-4057
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:ASP #500
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190
Practice Address - Country:US
Practice Address - Phone:630-933-4056
Practice Address - Fax:630-933-4057
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10794207T00000X
IL036-098187207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
206147OtherCDPG MEDICARE GROUP NO.
0222075OtherCDPG BLUE CROSS GROUP NO.
IL036098187Medicaid
IL036098187Medicaid
0222075OtherCDPG BLUE CROSS GROUP NO.