1831174291 NPI number — DR. HATEM SAYED EISSA M.D.

Table of content: DR. HATEM SAYED EISSA M.D. (NPI 1831174291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831174291 NPI number — DR. HATEM SAYED EISSA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EISSA
Provider First Name:
HATEM
Provider Middle Name:
SAYED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EISSA
Provider Other First Name:
AHMED
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831174291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1613 N. HARRISON PARKWAY
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-838-2371
Provider Business Mailing Address Fax Number:
954-851-1746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8900 NORTH KENDALL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-596-1960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  ME27971 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 035810000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78449 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".