Provider Demographics
NPI:1679033641
Name:AL-ANI, AWSSE HARITH HAMED (MBBS)
Entity type:Individual
Prefix:
First Name:AWSSE
Middle Name:HARITH HAMED
Last Name:AL-ANI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N FAIRBANKS CT FL 4
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3013
Mailing Address - Country:US
Mailing Address - Phone:561-628-8289
Mailing Address - Fax:
Practice Address - Street 1:710 N FAIRBANKS CT FL 4
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3013
Practice Address - Country:US
Practice Address - Phone:561-628-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA294504207R00000X
IL036.169608207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine