Healthcare Provider Details

I. General information

NPI: 1629350855
Provider Name (Legal Business Name): REHAM ABDOU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

4658 E VIA PIMERIA ALTA
TUCSON AZ
85718-3546
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5011
  • Fax: 602-655-9139
Mailing address:
  • Phone: 520-330-2418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number036.179560
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number56855
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number56855
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: