MEDICARE: NIDA A. MAROUF, D.M.D., LTD.

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		IL

General Provider Information

NPI Number	:	1427222645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIDA A. MAROUF, D.M.D., LTD.

Provider Business Mailing Address
First Line	:	2721 SUMMIT AVE
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-1325
Country	:	US
Telephone Number	:	847-681-2229
Fax Number	:

Provider Business Practice Location Address
First Line	:	5787 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4722
Country	:	US
Telephone Number	:	773-293-0606
Fax Number	:	773-751-5237

Authorized Official
Title or Position	:	PRESIDENT/DENTIST
Name	:	DR. NIDA A. MAROUF
Credential	:	D.M.D.
Telephone Number	:	773-293-0606

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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