Provider Demographics
NPI:1699750406
Name:SAWAN, RANDA M (MD)
Entity type:Individual
Prefix:
First Name:RANDA
Middle Name:M
Last Name:SAWAN
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 1:1304 DUNROBIN RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8282
Mailing Address - Country:US
Mailing Address - Phone:630-778-6775
Mailing Address - Fax:630-778-1281
Practice Address - Street 1:1304 DUNROBIN RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8282
Practice Address - Country:US
Practice Address - Phone:630-778-6775
Practice Address - Fax:630-778-1281
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098960207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098960Medicaid
ILK16000Medicare ID - Type Unspecified