Provider Demographics
NPI:1124139639
Name:MSO PHYSICIANS
Entity type:Organization
Organization Name:MSO PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-374-5316
Mailing Address - Street 1:2333 WAUKEGAN RD
Mailing Address - Street 2:SUITE175
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5508
Mailing Address - Country:US
Mailing Address - Phone:847-267-0801
Mailing Address - Fax:
Practice Address - Street 1:2449 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5647
Practice Address - Country:US
Practice Address - Phone:586-558-8435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty