Basic Information
| Provider Information | |||||||||
| NPI: | 1083016000 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EMAD F WISSA MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10632 N SCOTTSDALE RD | ||||||||
| Address2: | B-225 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852546164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806076825 | ||||||||
| FaxNumber: | 4806078133 | ||||||||
| Practice Location | |||||||||
| Address1: | 10632 N SCOTTSDALE RD | ||||||||
| Address2: | B-225 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852546164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806076825 | ||||||||
| FaxNumber: | 4806078133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2014 | ||||||||
| LastUpdateDate: | 09/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | WISSA | ||||||||
| AuthorizedOfficialFirstName: | EMAD | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4806076825 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 33025 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.