Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036-102166 | IL |
N | 208600000X | Surgeon | 036-102166 | IL |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 010-60761A | IN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036-102166 | IL |
NPI | 1023109899 |
---|---|
Provider Name | Ray Sawaqed |
First Address | Merrillville, IN 46410-6693 |
Second Address | Merrillville, IN 46410-6693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200528660 | (05) | IN |
I38512 | (02) |