MEDICARE: DR. AHMED M HEGAZY BDS.DMD

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	019.032103	IL

General Provider Information

NPI Number	:	1487211694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMED M HEGAZY BDS.DMD

Provider Business Mailing Address
First Line	:	1629 S PRAIRIE AVE UNIT 902
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-5058
Country	:	US
Telephone Number	:	646-270-0496
Fax Number	:

Provider Business Practice Location Address
First Line	:	7250 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5849
Country	:	US
Telephone Number	:	708-496-8896
Fax Number	:

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

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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