Provider Demographics
NPI:1265787881
Name:MAGDY K AWAD, MD, SC
Entity type:Organization
Organization Name:MAGDY K AWAD, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-854-9421
Mailing Address - Street 1:5311 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-1006
Mailing Address - Country:US
Mailing Address - Phone:773-586-0076
Mailing Address - Fax:773-586-0052
Practice Address - Street 1:5311 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-1006
Practice Address - Country:US
Practice Address - Phone:773-586-0076
Practice Address - Fax:773-586-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051586Medicaid
IL21609841OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
448280Medicare UPIN