Astacio, Mario Jose
Astacio, Mario Jose is an sole proprietor health care provider with primary practice located at 1140 N Mclean Blvd Suite C, Elgin IL 60123-1782. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Astacio, Mario Jose can be contacted via phone (224) 523-8971.Contact Information
Primary practice address
1140 N Mclean Blvd Suite C
Elgin IL 60123-1782
Phone: (224) 523-8971
Fax: (224) 220-0840
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 085-002516 | Illinois |
Profile Details
| NPI number | 1508073198 |
|---|---|
| LBN Legal business name | Astacio, Mario Jose |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 16th, 2007 |
| Last updated | Jan 20th, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508073198 | NPPES |
| Illinois | Other | 085-002516 | STATE PROVIDER LICENCE |
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