Provider Demographics
NPI:1902911050
Name:RAWDA, AYMAN (MD)
Entity Type:Individual
Prefix:
First Name:AYMAN
Middle Name:
Last Name:RAWDA
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 1:9939 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3767
Mailing Address - Country:US
Mailing Address - Phone:708-424-0900
Mailing Address - Fax:708-424-1715
Practice Address - Street 1:9939 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3767
Practice Address - Country:US
Practice Address - Phone:708-424-0900
Practice Address - Fax:708-424-1715
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID036119571208000000X
MN1025992080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119517Medicaid
MN748195000Medicaid
I59380Medicare UPIN
I59380Medicare UPIN