Search › Illinois › 207RC0000X
Mario Massullo, D.O
NPI 1043228158 · on the registry since 2006 · sole proprietor
Practice
- Address
- 1710 W. Court St.
Kankakee, IL 60901 - Phone
- (815) 936-3200
- Fax
- (815) 936-3203
Additional practice sites
- 100 Provena Way Ste C, Bourbonnais, IL
Registry record
- Primary taxonomy
- 207RC0000X
207RC0000X
- Also registered as
- 207RI0011X
207R00000X - Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2026-07-20
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois