Provider Demographics
NPI:1689440877
Name:DAOUD, AWNI OMAR
Entity Type:Individual
Prefix:
First Name:AWNI
Middle Name:OMAR
Last Name:DAOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 BELOIT AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-2605
Mailing Address - Country:US
Mailing Address - Phone:708-655-3008
Mailing Address - Fax:
Practice Address - Street 1:9100 BELOIT AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-2605
Practice Address - Country:US
Practice Address - Phone:708-655-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD30001458023344600000X
344600000X
ILD300-0145-8023405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
No344600000XTransportation ServicesTaxi