Provider Demographics
NPI:1457384109
Name:DHAWAN, AMAN (MD)
Entity Type:Individual
Prefix:
First Name:AMAN
Middle Name:
Last Name:DHAWAN
Suffix:
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 1:636 RAYMOND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9791
Mailing Address - Country:US
Mailing Address - Phone:630-355-5302
Mailing Address - Fax:630-778-6088
Practice Address - Street 1:636 RAYMOND DR STE 200
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-355-5302
Practice Address - Fax:630-778-6088
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920540OtherMEDICARE GROUP
ILF400409045OtherMEDICARE INDIVIDUAL