MEDICARE: WD SURGICARE LTD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1962019042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WD SURGICARE LTD

Provider Business Mailing Address
First Line	:	PO BOX 681176
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60168-1176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 S ROSELLE RD STE 104
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-2966
Country	:	US
Telephone Number	:	847-352-5511
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MR. WAJDE DABAH
Credential	:	MD
Telephone Number	:	847-325-5511

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	11/19/2020

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