| Hyde Park Medical Specialty Group, Llc | |
|
1644 E 53rd St Chicago IL 60615-4210 | |
| (773) 752-2111 | |
| (773) 752-6703 |
| Full Name | Hyde Park Medical Specialty Group, Llc |
|---|---|
| Speciality | Anesthesiology |
| Location | 1644 E 53rd St, Chicago, Illinois |
| Authorized Official Name and Position | Fortunee Massuda (MEDICAL DIRECTOR/CEO) |
| Authorized Official Contact | 7737522111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hyde Park Medical Specialty Group, Llc 9933 S Western Ave Suite 102 Chicago IL 60643-1810 Ph: (773) 233-3800 | Hyde Park Medical Specialty Group, Llc 1644 E 53rd St Chicago IL 60615-4210 Ph: (773) 752-2111 |
| NPI Number | 1588656037 |
|---|---|
| Provider Enumeration Date | 08/19/2005 |
| Last Update Date | 07/19/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588656037 | NPI | - | NPPES |
| 01633434 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Illinois) | Secondary |
| 207L00000X | Anesthesiology | (* (Not Available)) | Primary |
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