MEDICARE: ADAM SAAD MOSSALLATI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	301711	LA
2	208M00000X	Hospitalist Physician	301711	LA
3	207R00000X	Internal Medicine Physician	301711	LA

General Provider Information

NPI Number	:	1447517974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM SAAD MOSSALLATI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1684
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71165-1684
Country	:	US
Telephone Number	:	318-424-6004
Fax Number	:	858-230-1466

Provider Business Practice Location Address
First Line	:	1111 LINE AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-3841
Country	:	US
Telephone Number	:	318-716-4770
Fax Number	:	318-716-4791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2012
Last Update Date	:	06/07/2023

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