MEDICARE: DR. SOUSOU GAD AWAD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34954	AZ
2	207UN0901X	Nuclear Cardiology Physician	233802	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578631156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOUSOU GAD AWAD MD

Provider Business Mailing Address
First Line	:	3515 W UNION HILLS DR STE 111
Second Line	:	623-243-7842
City	:	GLENDALE
State	:	AZ
Zip	:	85308-2430
Country	:	US
Telephone Number	:	623-328-8630
Fax Number	:	623-243-7842

Provider Business Practice Location Address
First Line	:	3515 W UNION HILLS DR STE 111
Second Line	:	623-243-7842
City	:	GLENDALE
State	:	AZ
Zip	:	85308-2430
Country	:	US
Telephone Number	:	623-328-8630
Fax Number	:	623-243-7842

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	03/02/2017

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