Healthcare Provider Details

I. General information

NPI: 1689440877
Provider Name (Legal Business Name): AWNI OMAR DAOUD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 BELOIT AVE
BRIDGEVIEW IL
60455-2605
US

IV. Provider business mailing address

9100 BELOIT AVE
BRIDGEVIEW IL
60455-2605
US

V. Phone/Fax

Practice location:
  • Phone: 708-655-3008
  • Fax:
Mailing address:
  • Phone: 708-655-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License NumberD30001458023
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberD300-0145-8023
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: