Active NPI
Masum Kidiwala
- Medical-Surgical Registered Nurse
- Morton Grove, IL
National Provider Identifier
1245858935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical-Surgical Registered Nurse
- License
- 041476223
- Practice address
- 8841 Major Ave
Morton Grove, IL 60053-2531 - Phone
- (847) 899-2544
- NPI assigned
- Jul 8, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical-Surgical Registered Nurse | 163WM0705X | 041476223 | IL | Primary |
Addresses
Primary practice location
8841 Major Ave
Morton Grove, IL 60053-2531
Mailing address
8841 Major Ave
Morton Grove, IL 60053-2531
Phone (847) 899-2544
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041476223 | IL | MD | Medical-Surgical Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594166400000",
"number": "1245858935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8841 MAJOR AVE",
"city": "MORTON GROVE",
"state": "IL",
"postal_code": "600532531",
"telephone_number": "847-899-2544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8841 MAJOR AVE",
"city": "MORTON GROVE",
"state": "IL",
"postal_code": "600532531",
"telephone_number": "847-899-2544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDIWALA",
"first_name": "MASUM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-07-08",
"last_updated": "2020-07-08",
"certification_date": "2020-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163WM0705X",
"taxonomy_group": "",
"desc": "Registered Nurse, Medical-Surgical",
"state": "IL",
"license": "041476223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morton Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.