Healthcare Provider Details

I. General information

NPI: 1831174291
Provider Name (Legal Business Name): HATEM SAYED EISSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AHMED EISSA

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 NORTH KENDALL DRIVE
MIAMI FL
33176
US

IV. Provider business mailing address

1613 N. HARRISON PARKWAY #200
SUNRISE FL
33323-2853
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-1960
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME27971
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: