Healthcare Provider Details

I. General information

NPI: 1679541957
Provider Name (Legal Business Name): HOUSAM ALASALY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 N 44TH ST STE 103
PHOENIX AZ
85018-2782
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-0405
  • Fax: 602-954-0485
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number27108
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: