Healthcare Provider Details

I. General information

NPI: 1366173098
Provider Name (Legal Business Name): NAWAL MOIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 04/06/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST STE D308
SPRINGFIELD IL
62702-3757
US

IV. Provider business mailing address

701 N 1ST ST STE D308
SPRINGFIELD IL
62702-3757
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-4401
  • Fax:
Mailing address:
  • Phone: 217-788-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.085033.
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: