Provider Demographics
NPI:1699429316
Name:ABUAWAD, WAZEEN (LAB DIRECTOR)
Entity type:Individual
Prefix:
First Name:WAZEEN
Middle Name:
Last Name:ABUAWAD
Suffix:
Gender:M
Credentials:LAB DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 W 79TH PL
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1901
Mailing Address - Country:US
Mailing Address - Phone:708-682-2234
Mailing Address - Fax:
Practice Address - Street 1:6117 W 79TH PL
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1901
Practice Address - Country:US
Practice Address - Phone:708-682-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician