Provider Demographics
NPI:1093709438
Name:AL-QAWASMI, FOUAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FOUAD
Middle Name:
Last Name:AL-QAWASMI
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 1:7714 W 159TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5445
Mailing Address - Country:US
Mailing Address - Phone:708-429-2020
Mailing Address - Fax:708-598-0123
Practice Address - Street 1:7714 W 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5445
Practice Address - Country:US
Practice Address - Phone:708-429-2020
Practice Address - Fax:708-598-0123
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093184207V00000X
IL36093184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL80314OtherUNICARE PROVIDER #
IL542103696OtherTAX ID #
IL2355798/002OtherCIGNA PROVIDER #
IL01633764OtherBCBS PROVIDER #
IL7297478OtherAETNA PPO PROVIDER #
IL036093184Medicaid
IL207094OtherNATIONAL PROVIDER #
IL36093184OtherLICENSE #
IL3295748OtherAETNA HMO PROVIDER #
IL36093184OtherLICENSE #