Healthcare Provider Details

I. General information

NPI: 1669737862
Provider Name (Legal Business Name): HAMZA HADI A TANTOUSH MBBCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BYPASS RD BLDG A
PIKEVILLE KY
41501-1602
US

IV. Provider business mailing address

PO BOX 432
PIKEVILLE KY
41502-0432
US

V. Phone/Fax

Practice location:
  • Phone: 606-430-2208
  • Fax: 606-430-1994
Mailing address:
  • Phone: 606-430-2208
  • Fax: 606-430-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number10263
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number48350
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: