MEDICARE: IBRAAHIM BADAT 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	1223G0001X	General Practice Dentistry	019035282	IL

General Provider Information

NPI Number	:	1821834607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBRAAHIM BADAT DDS

Provider Business Mailing Address
First Line	:	1625 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-0367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-0367
Country	:	US
Telephone Number	:	312-846-6752
Fax Number	:

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

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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