MEDICARE: MAWUSI ARNETT M.D.

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	207Q00000X	Family Medicine Physician	336.110715	IL
2	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	036.149689	IL
3	207Q00000X	Family Medicine Physician	A183117	CA
4	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	336.110715	IL
5	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	A183117	CA
6	207Q00000X	Family Medicine Physician	036.149689	IL

General Provider Information

NPI Number	:	1063868313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAWUSI ARNETT M.D.

Provider Business Mailing Address
First Line	:	2045 W GRAND AVE STE B997773
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1576
Country	:	US
Telephone Number	:	312-834-4423
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 W GRAND AVE STE B997773
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1576
Country	:	US
Telephone Number	:	312-834-4423
Fax Number	:

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

Provider Enumeration Date	:	05/05/2016
Last Update Date	:	01/05/2025

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