Provider Demographics
NPI:1104048446
Name:GOLEWALE, MAZHAR (MD)
Entity type:Individual
Prefix:
First Name:MAZHAR
Middle Name:
Last Name:GOLEWALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S443 SUMMIT AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3973
Mailing Address - Country:US
Mailing Address - Phone:630-613-9800
Mailing Address - Fax:
Practice Address - Street 1:1S443 SUMMIT AVE 305
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3973
Practice Address - Country:US
Practice Address - Phone:630-613-9800
Practice Address - Fax:630-613-9865
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS61932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry