Healthcare Provider Details

I. General information

NPI: 1427587781
Provider Name (Legal Business Name): CHICAGO MATERNAL FETAL MEDICINE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 NORTH HALSTED STREET
CHICAGO IL
60614
US

IV. Provider business mailing address

2507 N HALSTED ST
CHICAGO IL
60614-9267
US

V. Phone/Fax

Practice location:
  • Phone: 773-348-8032
  • Fax: 773-348-8042
Mailing address:
  • Phone: 773-348-8032
  • Fax: 773-348-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number036085930
License Number StateIL

VIII. Authorized Official

Name: DR. NAWAR HATOUM
Title or Position: PRESIDENT
Credential: MD
Phone: 773-348-8032