Provider Demographics
NPI:1205185345
Name:MOTIWALA, AFAQ
Entity Type:Individual
Prefix:
First Name:AFAQ
Middle Name:
Last Name:MOTIWALA
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 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-5911
Mailing Address - Fax:708-327-2771
Practice Address - Street 1:1005 HARBORSIDE DR 6TH FL
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-6700
Practice Address - Country:US
Practice Address - Phone:409-772-2328
Practice Address - Fax:409-747-0777
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6458207RC0000X, 207RI0011X
IL036-138477207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease