MEDICARE: DR. HAMDALA HENRY ABUSHARIF M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician		IL

General Provider Information

NPI Number	:	1912912445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAMDALA HENRY ABUSHARIF M.D.

Provider Business Mailing Address
First Line	:	12766 S HARLEM AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2145
Country	:	US
Telephone Number	:	708-448-2626
Fax Number	:	708-448-0630

Provider Business Practice Location Address
First Line	:	12766 S HARLEM AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2145
Country	:	US
Telephone Number	:	708-448-2626
Fax Number	:	708-448-0630

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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