Provider Demographics
NPI:1356307375
Name:WISSA, EMAD F (MD)
Entity Type:Individual
Prefix:
First Name:EMAD
Middle Name:F
Last Name:WISSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EMAD
Other - Middle Name:F
Other - Last Name:WISSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6635 W HAPPY VALLEY RD STE A104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2609
Mailing Address - Country:US
Mailing Address - Phone:480-624-8080
Mailing Address - Fax:
Practice Address - Street 1:5555 W THUNDERBIRD ROAD.
Practice Address - Street 2:THUNDERBIRD HOSPITAL
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-298-1932
Practice Address - Fax:602-862-1131
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33025207RC0200X, 208M00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ868325Medicaid
AZ33025OtherAZ MD LIC
AZ868325Medicaid
AZZ117225Medicare PIN