Provider Demographics
NPI:1144656919
Name:SADDOUK INTERNAL MEDICINE CARE ASSOC LLC
Entity type:Organization
Organization Name:SADDOUK INTERNAL MEDICINE CARE ASSOC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOSPITALIST
Authorized Official - Prefix:
Authorized Official - First Name:YAMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SADDOUK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-374-9227
Mailing Address - Street 1:2525 W BERYL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-1606
Mailing Address - Country:US
Mailing Address - Phone:602-424-7967
Mailing Address - Fax:602-371-4960
Practice Address - Street 1:1301 S CRISMON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3767
Practice Address - Country:US
Practice Address - Phone:480-358-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1669655007Medicare NSC