Provider Demographics
NPI:1386660322
Name:ACQUAYE-AWAH, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ACQUAYE-AWAH
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 1:730 S CLARK ST
Mailing Address - Street 2:UNIT 403
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1743
Mailing Address - Country:US
Mailing Address - Phone:773-807-0555
Mailing Address - Fax:312-583-1558
Practice Address - Street 1:730 S CLARK ST
Practice Address - Street 2:UNIT 403
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1743
Practice Address - Country:US
Practice Address - Phone:773-807-0555
Practice Address - Fax:312-583-1558
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102126Medicaid
IL036102126Medicaid
ILK06533Medicare ID - Type Unspecified