Healthcare Provider Details

I. General information

NPI: 1427283290
Provider Name (Legal Business Name): SOFIA M ADAWY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747-51 WEST CERMAK ROAD
CICERO IL
60804-2508
US

IV. Provider business mailing address

2045 W. WASHINGTON BLVD
CHICAGO IL
60612-2428
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2000
  • Fax: 708-652-4745
Mailing address:
  • Phone: 312-413-1261
  • Fax: 312-413-7812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.129514
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: