MEDICARE: GADSTAR, P.C.

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		AZ

General Provider Information

NPI Number	:	1649719071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GADSTAR, P.C.

Provider Business Mailing Address
First Line	:	3515 W UNION HILLS DR STE 111
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-2430
Country	:	US
Telephone Number	:	623-328-8630
Fax Number	:	623-243-7842

Provider Business Practice Location Address
First Line	:	3515 W UNION HILLS DR STE 111
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-2430
Country	:	US
Telephone Number	:	623-328-8630
Fax Number	:	623-243-7842

Authorized Official
Title or Position	:	MEMBER/MANAGING EMPLOYEE
Name	:	MRS. SOUSOU GAD AWAD
Credential	:	M.D.
Telephone Number	:	480-389-7019

Provider Enumeration Date	:	02/17/2017
Last Update Date	:	02/17/2017

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