Provider Demographics
NPI:1881618395
Name:BERRUIN, AWAD M (MD)
Entity type:Individual
Prefix:DR
First Name:AWAD
Middle Name:M
Last Name:BERRUIN
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 1:2717 N 73RD ST APT 308
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6837
Mailing Address - Country:US
Mailing Address - Phone:402-390-0588
Mailing Address - Fax:
Practice Address - Street 1:2717 N 73RD ST APT 308
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6837
Practice Address - Country:US
Practice Address - Phone:402-390-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine