Healthcare Provider Details

I. General information

NPI: 1639128432
Provider Name (Legal Business Name): ABDEL ANWAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E HARRIS ST
CHARLOTTE MI
48813-1629
US

IV. Provider business mailing address

911 N ELM ST SUITE 215
HINSDALE IL
60521-3634
US

V. Phone/Fax

Practice location:
  • Phone: 517-541-5927
  • Fax: 517-543-0875
Mailing address:
  • Phone: 630-856-6865
  • Fax: 630-856-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number36067064
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: