MEDICARE: LAMA THERESE ELDAHDAH

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1639235955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAMA THERESE ELDAHDAH

Provider Business Mailing Address
First Line	:	2825 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5105
Country	:	US
Telephone Number	:	773-472-4900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2825 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5105
Country	:	US
Telephone Number	:	773-472-4900
Fax Number	:

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	05/12/2009

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Directions to “ LAMA THERESE ELDAHDAH ” Practice Location

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