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NPI Code Detail

MEDICARE: DR. EUGENE MERBAUM DDS

MEDICARE: DR. EUGENE MERBAUM 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
1122300000XDentistIL

General Provider Information

NPI Number : 1508976929
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EUGENE MERBAUM DDS
Provider Business Mailing Address
First Line : 3201 SOUTH WALLACE STREET
Second Line :
City : CHICAGO
State : IL
Zip : 60616-3501
Country : US
Telephone Number : 312-842-7846
Fax Number : 312-842-8340
Provider Business Practice Location Address
First Line : 3201 SOUTH WALLACE STREET
Second Line :
City : CHICAGO
State : IL
Zip : 60616-3501
Country : US
Telephone Number : 312-842-7846
Fax Number : 312-842-8340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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Directions to “ DR. EUGENE MERBAUM DDS” Practice Location

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