MEDICARE: DR. YASSER AHMED ELSEWEIFI DDS

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	122300000X	Dentist	019023492	IL

General Provider Information

NPI Number	:	1245429133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YASSER AHMED ELSEWEIFI DDS

Provider Business Mailing Address
First Line	:	2002 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4527
Country	:	US
Telephone Number	:	773-276-2757
Fax Number	:	773-276-2758

Provider Business Practice Location Address
First Line	:	2002 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4527
Country	:	US
Telephone Number	:	773-276-2757
Fax Number	:	773-276-2758

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

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	10/01/2013

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