Provider Demographics
NPI:1497739205
Name:ABUAWAD, MAZEN K (MD)
Entity Type:Individual
Prefix:
First Name:MAZEN
Middle Name:K
Last Name:ABUAWAD
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 1:7606 PEBBLE CREEK CIR APT 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-6525
Mailing Address - Country:US
Mailing Address - Phone:314-882-6277
Mailing Address - Fax:
Practice Address - Street 1:6101 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-348-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020081732085R0202X, 2085R0204X
IL0361049262085R0204X
NE211752085R0204X
FLME1107832085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
112315OtherHEALTHLINK
MO205896608Medicaid
FL008389900Medicaid
1602023OtherUHC
4964V4964OtherGHP
P00134160OtherTRAVELERS
140376000OtherDEPT. OF LABOR
431142188OSUOtherMERCY
MO1765OtherBCBS
140376000OtherDEPT. OF LABOR
431142188OSUOtherMERCY
4964V4964OtherGHP
019010520Medicare PIN