Provider Demographics
NPI:1407000813
Name:DR. JOHN AWAH & ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:DR. JOHN AWAH & ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AWAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-655-3720
Mailing Address - Street 1:9033 RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1655
Mailing Address - Country:US
Mailing Address - Phone:630-655-3720
Mailing Address - Fax:
Practice Address - Street 1:9033 RESERVE DR
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1655
Practice Address - Country:US
Practice Address - Phone:630-655-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
IL036102126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty