Provider Demographics
NPI:1003813262
Name:HALAWA, ABDUL (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:HALAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 BRONSONS WAY
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-3218
Mailing Address - Country:US
Mailing Address - Phone:330-963-5966
Mailing Address - Fax:
Practice Address - Street 1:13170 RAVENNA RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7025
Practice Address - Country:US
Practice Address - Phone:440-739-0420
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065825207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG18738Medicare UPIN
OHHA0811003Medicare ID - Type Unspecified