Provider Demographics
NPI:1346208519
Name:WASSEF, SAMIR Y (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:Y
Last Name:WASSEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:415 EAST NORTH WATER STREET
Mailing Address - Street 2:SUITE #2005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5824
Mailing Address - Country:US
Mailing Address - Phone:312-968-0000
Mailing Address - Fax:312-277-7500
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 330
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-227-0111
Practice Address - Fax:773-227-0006
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360863422080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086342Medicaid
IL036086342Medicaid