Active NPI
Angel Bassuk, MD
- Pediatric Surgery Physician
- Skokie, IL
National Provider Identifier
1407089923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Surgery Physician
- License
- 036-051092
- Practice address
- 9655 Woods Dr
Skokie, IL 60077-4418 - Phone
- (727) 460-4353
- NPI assigned
- Sep 1, 2009
- 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 |
|---|---|---|---|---|
| Pediatric Surgery Physician | 2086S0120X | 036-051092 | IL | Primary |
Addresses
Primary practice location
9655 Woods Dr
Skokie, IL 60077-4418
Mailing address
90 Kelleys TRL
Oldsmar, FL 34677-1976
Phone (727) 460-4353
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-051092 | IL | MD | Pediatric Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251763200000",
"number": "1407089923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 KELLEYS TRL",
"city": "OLDSMAR",
"state": "FL",
"postal_code": "346771976",
"telephone_number": "727-460-4353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9655 WOODS DR",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600774418",
"telephone_number": "727-460-4353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASSUK",
"first_name": "ANGEL",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-01",
"last_updated": "2009-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "IL",
"license": "036-051092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Skokie, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.