Healthcare Provider Details

I. General information

NPI: 1851966816
Provider Name (Legal Business Name): QONAIN BAWANY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MINNESOTA DR STE 800
EDINA MN
55435-7915
US

IV. Provider business mailing address

19W181 21ST PL
LOMBARD IL
60148-5010
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1100
  • Fax:
Mailing address:
  • Phone: 312-927-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036175710
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.078174
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: