Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 021.002386 | IL |
N | 1223G0001X | General Practice | 019.028388 | IL |
N | 213EG0000X | General Practice | 019.028388 | IL |
NPI | 1093907024 |
---|---|
Provider Name | Dr. Nermeen Mohamed Moussa |
First Address | Chicago, IL 60605 |
Second Address | Chicago, IL 60605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 23/04/2012 |