Healthcare Provider Details

I. General information

NPI: 1346208519
Provider Name (Legal Business Name): SAMIR Y WASSEF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W DIVISION ST SUITE 330
CHICAGO IL
60622-2717
US

IV. Provider business mailing address

415 EAST NORTH WATER STREET SUITE #2005
CHICAGO IL
60611-5824
US

V. Phone/Fax

Practice location:
  • Phone: 773-227-0111
  • Fax: 773-227-0006
Mailing address:
  • Phone: 312-968-0000
  • Fax: 312-277-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036086342
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: