Individual
FRI AWASUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2734 W 87TH ST, CHICAGO, IL 60652-3937
(773) 918-4700
Mailing address
1395 NW 167TH ST, MIAMI GARDENS, FL 33169-5710
(773) 918-4700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036157802
IL
Other
Enumeration date
05/07/2014
Last updated
09/29/2021
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