Provider Demographics
NPI:1609808153
Name:AWAD, AYMAN NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:AYMAN
Middle Name:NICHOLAS
Last Name:AWAD
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:PO BOX 6059
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216-6059
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:480-985-0468
Practice Address - Street 1:1944 MESQUITE AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5729
Practice Address - Country:US
Practice Address - Phone:928-505-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ202812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ470000882OtherRAIL ROAD MEDICARE
AZ470000882OtherRAIL ROAD MEDICARE
AZZ30WCLCN01Medicare PIN
AZZ60565Medicare PIN