MEDICARE: REEM MUTIAH OBAISI 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	019027619	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972766186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REEM MUTIAH OBAISI DDS

Provider Business Mailing Address
First Line	:	3334 W PETERSON AVE
Second Line	:	LOWER LEVEL
City	:	CHICAGO
State	:	IL
Zip	:	60659-3505
Country	:	US
Telephone Number	:	773-588-9200
Fax Number	:	773-588-9201

Provider Business Practice Location Address
First Line	:	3334 W PETERSON AVE
Second Line	:	LOWER LEVEL
City	:	CHICAGO
State	:	IL
Zip	:	60659-3505
Country	:	US
Telephone Number	:	773-588-9200
Fax Number	:	773-588-9201

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	09/28/2016

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