Provider Demographics
NPI:1457989295
Name:KISHAWI, DEENA (MD)
Entity type:Individual
Prefix:DR
First Name:DEENA
Middle Name:
Last Name:KISHAWI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1809
Mailing Address - Country:US
Mailing Address - Phone:773-501-7094
Mailing Address - Fax:
Practice Address - Street 1:18 IMPERIAL PLACE
Practice Address - Street 2:SUITE 2D
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-727-4800
Practice Address - Fax:401-921-6923
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
RIMD19850207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program