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Provider Information for 1629247572



DR. EMAD E AZAB D.D.S

Gender: MALE

Individual NPI: 1629247572

Calendar Last Updated: 2008-02-25

Details

Name Value
NPI 1629247572
Enumeration Date 2008-02-25
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 4703 W LAWRENCE AVE
CHICAGO, IL 60630-1722
United States

Phone: 773-205-9900 | Fax: 773-205-9970
View Map External Link
Primary Practice Address 4703 W LAWRENCE AVE
CHICAGO, IL 60630-1722
United States

Phone: 773-205-9900 | Fax: 773-205-9970
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist IL