Provider Demographics
NPI:1639056724
Name:ALTWAL, RAWAN
Entity type:Individual
Prefix:
First Name:RAWAN
Middle Name:
Last Name:ALTWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17310 LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3481
Mailing Address - Country:US
Mailing Address - Phone:248-521-4062
Mailing Address - Fax:
Practice Address - Street 1:17310 LOUISE ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3481
Practice Address - Country:US
Practice Address - Phone:248-521-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide