MEDICARE: AYMAN NICHOLAS AWAD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	20281	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	470000882	OTHER	AZ	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1609808153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYMAN NICHOLAS AWAD MD

Provider Business Mailing Address
First Line	:	PO BOX 6059
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85216-6059
Country	:	US
Telephone Number	:	480-985-1093
Fax Number	:	480-985-0468

Provider Business Practice Location Address
First Line	:	1944 MESQUITE AVE
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5729
Country	:	US
Telephone Number	:	928-505-9729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	05/22/2013

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