Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 019029609 | IL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 019-029609 | IL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 019029609 | IL |
NPI | 1538592654 |
---|---|
Provider Name | Dr. Matthew Seena Hamedani |
First Address | Berwyn, IL 60402-3031 |
Second Address | Berwyn, IL 60402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2013 |
Last Update Date | 09/12/2021 |