Provider Demographics
NPI:1336106186
Name:SAMKARI, MHD KUSSAY AL (MD)
Entity Type:Individual
Prefix:DR
First Name:MHD KUSSAY
Middle Name:AL
Last Name:SAMKARI
Suffix:
Gender:M
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 10741
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0013
Mailing Address - Country:US
Mailing Address - Phone:602-741-5504
Mailing Address - Fax:602-207-8899
Practice Address - Street 1:436 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5216
Practice Address - Country:US
Practice Address - Phone:480-887-0243
Practice Address - Fax:602-207-8899
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ947012Medicaid
AZ947012Medicaid
AZZ104042Medicare PIN
AZI34098Medicare UPIN