Basic Information
| Provider Information | |||||||||
| NPI: | 1144656919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SADDOUK INTERNAL MEDICINE CARE ASSOC LLC | ||||||||
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| OtherOrganizationName: | SADDOUK INTERNAL MEDICINE CARE ASSOCIATES LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 W BERYL AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850211606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024247967 | ||||||||
| FaxNumber: | 6023714960 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 S CRISMON RD | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852093767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803586100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2013 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | SADDOUK | ||||||||
| AuthorizedOfficialFirstName: | YAMINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | HOSPITALIST | ||||||||
| AuthorizedOfficialTelephone: | 4803749227 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.