Healthcare Provider Details

I. General information

NPI: 1902911050
Provider Name (Legal Business Name): AYMAN RAWDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 SOUTHWEST HWY
OAK LAWN IL
60453-3767
US

IV. Provider business mailing address

9939 SOUTHWEST HWY
OAK LAWN IL
60453-3767
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-0900
  • Fax: 708-424-1715
Mailing address:
  • Phone: 708-424-0900
  • Fax: 708-424-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036119571
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: