1497739205 NPI number — MAZEN K ABUAWAD M.D.

Table of content: MAZEN K ABUAWAD M.D. (NPI 1497739205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497739205 NPI number — MAZEN K ABUAWAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABUAWAD
Provider First Name:
MAZEN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497739205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7606 PEBBLE CREEK CIR APT 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34108-6525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-882-6277
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6101 PINE RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34119-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-348-4221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  2002008173 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 2002008173 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 036104926 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 21175 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: ME110783 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112315 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205896608 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008389900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1602023 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4964V4964 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00134160 . This is a "TRAVELERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140376000 . This is a "DEPT. OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431142188OSU . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1765 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 008389900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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