Provider Demographics
NPI:1083016000
Name:EMAD F WISSA MD PC
Entity Type:Organization
Organization Name:EMAD F WISSA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:F
Authorized Official - Last Name:WISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-487-0073
Mailing Address - Street 1:10632 N SCOTTSDALE RD
Mailing Address - Street 2:B-225
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6164
Mailing Address - Country:US
Mailing Address - Phone:480-607-6825
Mailing Address - Fax:480-607-8133
Practice Address - Street 1:5555 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4622
Practice Address - Country:US
Practice Address - Phone:480-487-0073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33025174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty