Ossama Azzam, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019029676 Issued in IL

Practice address

4901 N Kedzie Ave
Chicago, IL 60625-5009

Phone

(773) 509-9200

NPI assigned

Nov 4, 2013

Last updated

Dec 26, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388016000000",
    "number": "1649609298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606255009",
            "telephone_number": "773-509-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606255009",
            "telephone_number": "773-509-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZZAM",
        "first_name": "OSSAMA",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-04",
        "last_updated": "2013-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019029676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elyse Azriel, MS, MA, CRC, LPC
• Evelyn Angel Aztlan-Keahey, N.P.
• Eric Neil Azua
• Azul Holistic Spa
• Mudar Azzam, DDS
• Ruba Azzam
• B & G Heinz Pharmacy, Inc
• B & K Drug Inc.
• B & M Trasportation LLC (LM)
• B and B Mental Health LLC

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.