Provider Demographics
NPI:1588994271
Name:QANDEEL, HISHAM G (MBBS)
Entity type:Individual
Prefix:
First Name:HISHAM
Middle Name:G
Last Name:QANDEEL
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 PENNSYLVANIA AVE STE 680
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2133
Mailing Address - Country:US
Mailing Address - Phone:817-250-4235
Mailing Address - Fax:817-885-7701
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 680
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2133
Practice Address - Country:US
Practice Address - Phone:817-250-4235
Practice Address - Fax:817-885-7701
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54858208600000X, 208G00000X
WAMD60722201208G00000X
TXR9841208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN020003208Medicare PIN