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General NPI Number Information
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NPI Number | 1043913304
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Entity Type | Individual
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Provider Name | RAWAN WAGIEALLA M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL 225 EAST CHICAGO AVENUE
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-227-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 118 MOUNT VERNON STREET APARTMENT 1
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City | BOSTON
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State | MA
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Zip | 02108
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Country | US
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Telephone | 857-829-0800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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