Healthcare Provider Details

I. General information

NPI: 1679549299
Provider Name (Legal Business Name): NAWAR HATOUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/24/2020
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 N HALSTED ST CHICAGO MATERNAL FETAL MEDICINE, S.C
CHICAGO IL
60614-9267
US

IV. Provider business mailing address

2507 N HALSTED ST CHICAGO MATERNAL FETAL MEDICINE, S.C
CHICAGO IL
60614-9267
US

V. Phone/Fax

Practice location:
  • Phone: 773-348-8032
  • Fax: 773-348-8042
Mailing address:
  • Phone: 773-348-8032
  • Fax: 773-348-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number036-085930
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: