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General NPI Number Information
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NPI Number | 1649719071
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Entity Type | Organization
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Legal Business Name | GADSTAR, P.C.
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 3515 W UNION HILLS DR STE 111
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City | GLENDALE
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State | AZ
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Zip | 85308-2430
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Country | US
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Telephone | 623-328-8630
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Fax | 623-243-7842
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Provider Business Mailing Address
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Address Line | 3515 W UNION HILLS DR STE 111
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City | GLENDALE
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State | AZ
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Zip | 85308-2430
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Country | US
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Telephone | 623-328-8630
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Fax | 623-243-7842
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Authorized Official
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Title or Position | MEMBER/MANAGING EMPLOYEE
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Name | MRS. SOUSOU GAD AWAD
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Credential | M.D.
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Telephone | 480-389-7019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | AZ
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