Provider Demographics
NPI:1912981242
Name:WAZWAZ, HESHAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:HESHAM
Middle Name:A
Last Name:WAZWAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10741 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6305
Mailing Address - Country:US
Mailing Address - Phone:872-267-5025
Mailing Address - Fax:872-267-5019
Practice Address - Street 1:10448 S PULASKI RD
Practice Address - Street 2:SUITE 3
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4895
Practice Address - Country:US
Practice Address - Phone:708-634-7404
Practice Address - Fax:708-634-7407
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103718207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103718Medicaid
IL036103718Medicaid