Provider Demographics
NPI:1891751996
Name:DR BADI ALTAWIL MD LLC
Entity Type:Organization
Organization Name:DR BADI ALTAWIL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTAWIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-847-6527
Mailing Address - Street 1:4439A MAHONING AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1932
Mailing Address - Country:US
Mailing Address - Phone:330-847-6527
Mailing Address - Fax:330-847-6572
Practice Address - Street 1:4439A MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1932
Practice Address - Country:US
Practice Address - Phone:330-847-6527
Practice Address - Fax:330-847-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2137842Medicaid
OH2137842Medicaid
DR9342291Medicare ID - Type Unspecified