1528419173 NPI number — DR. JOHN DANIEL AWAD M.D.

Table of content: DR. JOHN DANIEL AWAD M.D. (NPI 1528419173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528419173 NPI number — DR. JOHN DANIEL AWAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AWAD
Provider First Name:
JOHN
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
DR.
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:
1528419173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 STEWART RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48162-4222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-240-8430
Provider Business Mailing Address Fax Number:
734-249-8495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7740 EL CAMINO REAL STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92009-8514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-383-2352
Provider Business Practice Location Address Fax Number:
619-488-6900
Provider Enumeration Date:
06/24/2016

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A162388 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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