1023222791 NPI number — MUSTAFA AWILI MD

Table of content: MUSTAFA AWILI MD (NPI 1023222791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023222791 NPI number — MUSTAFA AWILI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AWILI
Provider First Name:
MUSTAFA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1023222791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 661247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75266-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-320-7770
Provider Business Mailing Address Fax Number:
214-320-7654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2704 N GALLOWAY AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150-6379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-320-7650
Provider Business Practice Location Address Fax Number:
833-535-1075
Provider Enumeration Date:
05/10/2007

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: 207R00000X , with the licence number:  P0003 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: P0003 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2964832 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 613154600 . This is a "BLACK LUNG/FECA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810015411 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9272783 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7100095980 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000275183 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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