Provider Demographics
NPI:1205934395
Name:DARWEESH, MUTAZZ H (MD)
Entity type:Individual
Prefix:DR
First Name:MUTAZZ
Middle Name:H
Last Name:DARWEESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1801 WEST 47TH STREET
Mailing Address - Street 2:CHILDRENS MEDICAL CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609
Mailing Address - Country:US
Mailing Address - Phone:773-847-9004
Mailing Address - Fax:773-847-9008
Practice Address - Street 1:1801 WEST 47TH STREET
Practice Address - Street 2:CHILDRENS MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-3872
Practice Address - Country:US
Practice Address - Phone:773-847-9004
Practice Address - Fax:773-847-9008
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK27357Medicare ID - Type Unspecified
IL213524Medicare ID - Type UnspecifiedINTERNAL MEDICINE