Provider Demographics
NPI:1205333994
Name:BADWAN, HAMZEH OMAR I (MD)
Entity type:Individual
Prefix:
First Name:HAMZEH
Middle Name:OMAR
Last Name:BADWAN
Suffix:I
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 1:1490 E WALNUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1833
Mailing Address - Country:US
Mailing Address - Phone:815-432-7693
Mailing Address - Fax:815-936-7228
Practice Address - Street 1:1490 E WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1833
Practice Address - Country:US
Practice Address - Phone:815-432-7693
Practice Address - Fax:815-936-7228
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036158327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program