Provider Demographics
NPI:1639751456
Name:ABUHALAWEH, MUTASEM AHMAD KHALED (MD)
Entity type:Individual
Prefix:
First Name:MUTASEM
Middle Name:AHMAD KHALED
Last Name:ABUHALAWEH
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1300 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3592
Mailing Address - Country:US
Mailing Address - Phone:708-580-9954
Mailing Address - Fax:
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3592
Practice Address - Country:US
Practice Address - Phone:708-580-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.167350207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine