Healthcare Provider Details

I. General information

NPI: 1760446702
Provider Name (Legal Business Name): ELIA J. SAADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/26/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 N MOPAC EXPY
AUSTIN TX
78758-2401
US

IV. Provider business mailing address

12221 N MOPAC EXPY
AUSTIN TX
78758-2401
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4010
  • Fax: 512-901-3910
Mailing address:
  • Phone: 512-901-4010
  • Fax: 512-901-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberJ5196
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: