Healthcare Provider Details

I. General information

NPI: 1245437086
Provider Name (Legal Business Name): SAWSAN MOKHTAR MOSTAFA AWAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NA NA NA MD

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY RUSH UNIVERSITY MEDICAL CENTER
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

400 E SOUTH WATER ST APT.# 2202
CHICAGO IL
60601-4021
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-7496
  • Fax:
Mailing address:
  • Phone: 216-702-8035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036113906
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-113906
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036-113906
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: