Provider Demographics
NPI:1407959893
Name:METROPOLITAN NEOPEDIATRIX
Entity Type:Organization
Organization Name:METROPOLITAN NEOPEDIATRIX
Other - Org Name:METROPEDIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:YOUSEF
Authorized Official - Last Name:WASSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-968-0000
Mailing Address - Street 1:415 E NORTH WATER ST
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 C/O DR. WASSEF
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360863422080N0001X
MIA4310573542080N0001X
HI97302080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL645650Medicaid
IL645650Medicaid