Provider Demographics
NPI:1801985494
Name:ABRAHAM I AWWAD DO, LLC
Entity type:Organization
Organization Name:ABRAHAM I AWWAD DO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:AWWAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-322-0245
Mailing Address - Street 1:3622 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1345
Mailing Address - Country:US
Mailing Address - Phone:727-322-0245
Mailing Address - Fax:727-323-0994
Practice Address - Street 1:3622 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1345
Practice Address - Country:US
Practice Address - Phone:727-322-0245
Practice Address - Fax:727-323-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 7025207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254983200Medicaid
FL254983200Medicaid
FL43775YMedicare PIN
FL43775Medicare PIN