Provider Demographics
NPI:1629052089
Name:BAWEJA, MANSOINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOINA
Middle Name:
Last Name:BAWEJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SPALDING DR
Mailing Address - Street 2:STE 111
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6766
Mailing Address - Country:US
Mailing Address - Phone:630-527-3788
Mailing Address - Fax:630-646-6071
Practice Address - Street 1:120 SPALDING DR
Practice Address - Street 2:STE 111
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6766
Practice Address - Country:US
Practice Address - Phone:630-527-3788
Practice Address - Fax:630-646-6071
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85565207RH0003X
IL036119257207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119257 1Medicaid
FL265524100Medicaid
FL57791OtherBLUECROSS/BLUESHIELD
FLP00000944OtherRAILROAD MEDICARE
ILR01536Medicare PIN
FLP00000944OtherRAILROAD MEDICARE
ILR01537Medicare PIN
FL265524100Medicaid
FL57791ZMedicare ID - Type Unspecified
IL036119257 1Medicaid