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General NPI Number Information
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NPI Number | 1477089969
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Entity Type | Individual
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Provider Name | HISHAM ALWAKKAA
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Gender | Male
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 2521 CEDAR HILL LN
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City | WOODRIDGE
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State | IL
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Zip | 60517-4273
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Country | US
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Telephone | 203-212-7241
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Fax |
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Provider Business Mailing Address
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Address Line | 2521 CEDAR HILL LN
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City | WOODRIDGE
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State | IL
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Zip | 60517-4273
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Country | US
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Telephone | 203-212-7241
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 70164
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036163665
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 163655
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License Number State | IL
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