MEDICARE: METROPOLITAN NEOPEDIATRIX, SC

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
1	2080N0001X	Neonatal-Perinatal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1622066	OTHER	IL	BLUE CROSS / BLUE SHIELD

General Provider Information

NPI Number	:	1447218615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPOLITAN NEOPEDIATRIX, SC

Provider Business Mailing Address
First Line	:	415 EAST NORTH WATER STREET
Second Line	:	SUITE #2005
City	:	CHICAGO
State	:	IL
Zip	:	60611-5824
Country	:	US
Telephone Number	:	312-968-0000
Fax Number	:	312-277-7500

Provider Business Practice Location Address
First Line	:	2222 W DIVISION ST
Second Line	:	SUITE 330
City	:	CHICAGO
State	:	IL
Zip	:	60622-2717
Country	:	US
Telephone Number	:	773-227-0111
Fax Number	:	773-227-0006

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. SAMIR Y WASSEF
Credential	:	M.D.
Telephone Number	:	312-968-0000

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	04/09/2009

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Directions to “METROPOLITAN NEOPEDIATRIX, SC ” Practice Location

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