Provider Demographics
NPI:1164731378
Name:ELHALAWANY, EMAD
Entity Type:Individual
Prefix:
First Name:EMAD
Middle Name:
Last Name:ELHALAWANY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CATON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-5635
Mailing Address - Country:US
Mailing Address - Phone:708-323-7608
Mailing Address - Fax:708-286-6461
Practice Address - Street 1:1701 CATON RIDGE DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5635
Practice Address - Country:US
Practice Address - Phone:708-323-7608
Practice Address - Fax:708-286-6461
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070006796OtherSTATE OF IL 070006796