Healthcare Provider Details

I. General information

NPI: 1629208434
Provider Name (Legal Business Name): WASSIM T. RADWAN ABD EL WAHAB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N STE 360
ALLEN TX
75013-6111
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-6042
  • Fax: 972-747-6043
Mailing address:
  • Phone: 501-851-7402
  • Fax: 501-851-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-7609
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-7609
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU3441
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: