Provider Demographics
NPI:1710952635
Name:AWWAD, AMAL A (MD)
Entity type:Individual
Prefix:DR
First Name:AMAL
Middle Name:A
Last Name:AWWAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11175 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5615
Mailing Address - Country:US
Mailing Address - Phone:352-686-8888
Mailing Address - Fax:
Practice Address - Street 1:11175 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5615
Practice Address - Country:US
Practice Address - Phone:352-686-8888
Practice Address - Fax:352-684-6888
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072577207V00000X
FLME133087207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021793200Medicaid
NM43188273Medicaid
MI4590021Medicaid