Individual provider Active NPI

Abdullah Tawakul, M.D.

  • Vascular Neurology Physician
  • Milwaukee, WI
National Provider Identifier
1629485222
Registry record updated Jan 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Neurology PhysicianTaxonomy code 2084V0102X
License
63974 Issued in WI
Practice address
9200 W Wisconsin Ave
Department of Neurology
Milwaukee, WI 53226-3522
Phone
(414) 805-5200
Fax
(414) 259-0469
NPI assigned
Jul 15, 2014
Reactivated
Mar 24, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Neurology Physician 2084V0102X 63974 WI Primary
Neurology Physician 2084N0400X 63974 WI
Vascular Neurology Physician 2084V0102X 259476 MA

Addresses

Primary practice location

9200 W Wisconsin Ave
Department of Neurology
Milwaukee, WI 53226-3522

Mailing address

9200 W Wisconsin Ave
Department of Neurology
Milwaukee, WI 53226-3522
Phone (414) 805-5200

Other identifiers 1

IdentifierTypeStateIssuer
1629485222MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
63974WIMDNeurology Physician
259476MAMDVascular Neurology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452556800000",
    "number": "1629485222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "address_2": "DEPARTMENT OF NEUROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-5200",
            "fax_number": "414-259-0469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "address_2": "DEPARTMENT OF NEUROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-5200",
            "fax_number": "414-259-0469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAWAKUL",
        "first_name": "ABDULLAH",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-15",
        "last_updated": "2016-01-12",
        "deactivation_date": "2015-02-16",
        "reactivation_date": "2015-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "WI",
            "license": "63974",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "63974",
            "primary": false
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "MA",
            "license": "259476",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629485222",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.