Provider Demographics
NPI:1104015015
Name:GOODYEAR FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:GOODYEAR FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-925-5660
Mailing Address - Street 1:10320 W MCDOWELL RD
Mailing Address - Street 2:BLDG. I, STE#9029
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4863
Mailing Address - Country:US
Mailing Address - Phone:623-925-5660
Mailing Address - Fax:623-932-3898
Practice Address - Street 1:10320 W MCDOWELL RD
Practice Address - Street 2:BLDG. I, STE.9029
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4863
Practice Address - Country:US
Practice Address - Phone:623-925-5660
Practice Address - Fax:623-932-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28344261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ108537Medicare PIN
AZH25694Medicare UPIN