Provider Demographics
NPI:1457582926
Name:HASANAT, REWA MAHMOUD (MD)
Entity Type:Individual
Prefix:DR
First Name:REWA
Middle Name:MAHMOUD
Last Name:HASANAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27702 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1277
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-862-1781
Practice Address - Street 1:15300 WEST AVE STE 20
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4504
Practice Address - Country:US
Practice Address - Phone:708-460-5550
Practice Address - Fax:708-226-2595
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036131285Medicaid
IL231199026OtherMEDICARE
ILP01148828OtherRRM