Provider Demographics
NPI:1043606619
Name:ENAKUAA, SOUAD (MD)
Entity Type:Individual
Prefix:
First Name:SOUAD
Middle Name:
Last Name:ENAKUAA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57336
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7336
Mailing Address - Country:US
Mailing Address - Phone:281-724-8333
Mailing Address - Fax:281-336-1680
Practice Address - Street 1:600 N KOBAYASHI STE 312
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-8333
Practice Address - Fax:281-336-1680
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7207207R00000X, 207RE0101X, 207RE0101X
MA262492208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110104581AMedicaid
MAS400335264Medicare PIN