Provider Demographics
NPI:1548297500
Name:HAMDA, HOSSAM KHAMIS (MBCHB)
Entity type:Individual
Prefix:DR
First Name:HOSSAM
Middle Name:KHAMIS
Last Name:HAMDA
Suffix:
Gender:M
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LOTHROP ST DEPT OF
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:740-504-9671
Mailing Address - Fax:414-259-9290
Practice Address - Street 1:200 LOTHROP ST # E204
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2536
Practice Address - Country:US
Practice Address - Phone:412-647-0104
Practice Address - Fax:414-259-9290
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47313- 0202085R0202X
PAMD4595072085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1548297500Medicaid
WI058U 73-601Medicare ID - Type UnspecifiedMILWAUKEE COUNTY
WI1548297500Medicaid