Healthcare Provider Details

I. General information

NPI: 1104864461
Provider Name (Legal Business Name): HESHAM MORSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N 1ST ST STE 250
BOISE ID
83702-6132
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-9385
  • Fax:
Mailing address:
  • Phone:
  • Fax: 855-405-5837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM3035
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberM3035
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMC-1509
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: