Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036-142725 | IL |
N | 2084N0600X | Clinical Neurophysiologist | 036-142725 | IL |
NPI | 1023376951 |
---|---|
Provider Name | Dr. Abdullah Alsawaf |
First Address | Springfield, IL 62702-4968 |
Second Address | Springfield, IL 62702-4968 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2012 |
Last Update Date | 16/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036142725 | (05) | IL |