MEDICARE: MRS. DALLAL W ABDELSAYED 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	207Q00000X	Family Medicine Physician	G6694	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4388704	OTHER	TX	AETNA PROVIDER #

General Provider Information

NPI Number	:	1649345216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DALLAL W ABDELSAYED M.D.

Provider Business Mailing Address
First Line	:	607 E WALLISVILLE RD
Second Line	:
City	:	HIGHLANDS
State	:	TX
Zip	:	77562-3831
Country	:	US
Telephone Number	:	281-426-8586
Fax Number	:	281-426-7983

Provider Business Practice Location Address
First Line	:	607 E WALLISVILLE RD
Second Line	:
City	:	HIGHLANDS
State	:	TX
Zip	:	77562-3831
Country	:	US
Telephone Number	:	281-426-8586
Fax Number	:	281-426-7983

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	06/30/2010

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