MEDICARE: WASSIM KHALED CHOUCAIR 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	207RC0000X	Cardiovascular Disease Physician	L4299	TX
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	L4299	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

General Provider Information

NPI Number	:	1962496620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WASSIM KHALED CHOUCAIR M.D.

Provider Business Mailing Address
First Line	:	8122 DATAPOINT DR
Second Line	:	STE 120
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3272
Country	:	US
Telephone Number	:	210-998-6900
Fax Number	:	210-998-6907

Provider Business Practice Location Address
First Line	:	8122 DATAPOINT DR
Second Line	:	STE 120
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3272
Country	:	US
Telephone Number	:	210-998-6900
Fax Number	:	210-998-6907

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/22/2022

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