Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 019.032835 | IL |
NPI | 1083224257 |
---|---|
Provider Name | Mohammad Waseem Hussein Jamaleddin |
First Address | Oak Park, IL 60302-3279 |
Second Address | Chicago, IL 60647-4434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2020 |
Last Update Date | 13/08/2020 |