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NPI Code Detail

MEDICARE: DR. HOSSAM ALHABACH M.D.

MEDICARE: DR. HOSSAM ALHABACH 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
12084N0400XNeurology Physician060111CT
22084N0600XClinical Neurophysiology Physician060111CT
32084N0600XClinical Neurophysiology Physician33487AZ
42084N0400XNeurology Physician33487AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578527701
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HOSSAM ALHABACH M.D.
Provider Business Mailing Address
First Line : PO BOX 64551
Second Line :
City : PHOENIX
State : AZ
Zip : 85082-4551
Country : US
Telephone Number : 602-315-9820
Fax Number :
Provider Business Practice Location Address
First Line : 250 E DUNLAP AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-2825
Country : US
Telephone Number : 602-315-9820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 05/05/2020

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