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NPI Code Detail

MEDICARE: ASMAMAW KASSIE BEYENE M.D., M.P.H

MEDICARE: ASMAMAW KASSIE BEYENE M.D., M.P.H
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician03119662IL

General Provider Information

NPI Number : 1326161241
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASMAMAW KASSIE BEYENE M.D., M.P.H
Provider Business Mailing Address
First Line : 2220 COLLEGE RD
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60516-1033
Country : US
Telephone Number : 630-297-8376
Fax Number : 312-491-5020
Provider Business Practice Location Address
First Line : 2233 W DIVISION ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-8151
Country : US
Telephone Number : 312-770-2128
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2007
Last Update Date : 11/05/2020

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