Healthcare Provider Details

I. General information

NPI: 1851553408
Provider Name (Legal Business Name): AUDREY OWARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON ST
NAPERVILLE IL
60540-7430
US

IV. Provider business mailing address

387 SHUMAN BLVD SUITE 240W
NAPERVILLE IL
60563-8450
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-0450
  • Fax:
Mailing address:
  • Phone: 630-355-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMT192443
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: