Provider Demographics
NPI:1134114812
Name:NAWAS, SAMMY ISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMMY
Middle Name:ISSA
Last Name:NAWAS
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 1:10604 SOUTHWEST HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2704
Mailing Address - Country:US
Mailing Address - Phone:708-346-4065
Mailing Address - Fax:708-423-5799
Practice Address - Street 1:10604 SOUTHWEST HWY STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415
Practice Address - Country:US
Practice Address - Phone:708-346-4065
Practice Address - Fax:708-423-5799
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094091208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200543370CMedicaid
IL01618941OtherBCBS
IL036064091Medicaid
IN200543370BMedicaid
IN200543370CMedicaid
ILK18519Medicare PIN
ILF400094636Medicare PIN
IL01618941OtherBCBS
ILP00236271Medicare PIN