Provider Demographics
NPI:1578585089
Name:AWAD, TONY (DO)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:AWAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ANTON
Other - Middle Name:
Other - Last Name:AWAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1 FORD PL STE 2E
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3450
Mailing Address - Country:US
Mailing Address - Phone:313-874-3953
Mailing Address - Fax:313-876-1305
Practice Address - Street 1:1 FORD PL STE 2E
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-874-3953
Practice Address - Fax:313-876-1305
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011395207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4237162-11Medicaid
MI0M78440009Medicare ID - Type Unspecified
MI4237162-11Medicaid
MI050076602Medicare ID - Type UnspecifiedRAILROAD MEDICARE