MEDICARE: DR. BASSAM OSMAN 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	2084N0400X	Neurology Physician	036052025	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215937628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASSAM OSMAN M.D.

Provider Business Mailing Address
First Line	:	36748 TREASURY CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60694-6700
Country	:	US
Telephone Number	:	630-715-9327
Fax Number	:	630-736-6041

Provider Business Practice Location Address
First Line	:	2525 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2333
Country	:	US
Telephone Number	:	630-715-9327
Fax Number	:	630-736-6041

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	10/03/2013

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