Basic Information
| Provider Information | |||||||||
| NPI: | 1730388497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUAWAD | ||||||||
| FirstName: | NICOLAS | ||||||||
| MiddleName: | JANO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 2431 S M 30 | ||||||||
| Address2: | |||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486619312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893433264 | ||||||||
| FaxNumber: | 9893433202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 08/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4301090259 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0129X | 4301090259 | MI | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.