Healthcare Provider Details

I. General information

NPI: 1023109899
Provider Name (Legal Business Name): RAY SAWAQED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12251 S 80TH AVE STE 1520
PALOS HEIGHTS IL
60463-1290
US

IV. Provider business mailing address

8777 BROADWAY STE C
MERRILLVILLE IN
46410-6693
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-4200
  • Fax: 708-923-4201
Mailing address:
  • Phone: 219-769-7800
  • Fax: 219-738-3864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-102166
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number010-60761A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036102166
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: