Basic Information
| Provider Information | |||||||||
| NPI: | 1053774463 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISHARA | ||||||||
| FirstName: | AMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4965 CARTAGENA DR | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436232973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192664761 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 CENTER ST | ||||||||
| Address2: | CWEB , ROOM 1538 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366043301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514343915 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2016 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.