MEDICARE: WISAM MUSA

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	1223G0001X	General Practice Dentistry	019033348	IL

General Provider Information

NPI Number	:	1487110029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WISAM MUSA

Provider Business Mailing Address
First Line	:	2500 METROHEALTH DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1900
Country	:	US
Telephone Number	:	216-778-4486
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 E 93RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3607
Country	:	US
Telephone Number	:	773-530-7550
Fax Number	:	773-530-0287

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

Provider Enumeration Date	:	02/19/2019
Last Update Date	:	11/08/2021

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Directions to “ WISAM MUSA ” Practice Location

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