MEDICARE: MAHA SAWWAN

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	122300000X	Dentist	019.032654	IL

General Provider Information

NPI Number	:	1457959108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHA SAWWAN

Provider Business Mailing Address
First Line	:	7250 S CICERO AVE STE F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7250 S CICERO AVE STE F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5849
Country	:	US
Telephone Number	:	708-496-8896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/29/2020

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Directions to “ MAHA SAWWAN ” Practice Location

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