Provider Demographics
NPI:1497217145
Name:JEREMIAH SISAY, PHARMD, MD, PLLC
Entity Type:Organization
Organization Name:JEREMIAH SISAY, PHARMD, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SISAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-288-1662
Mailing Address - Street 1:2698 N GALLOWAY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6384
Mailing Address - Country:US
Mailing Address - Phone:972-288-1662
Mailing Address - Fax:972-289-3075
Practice Address - Street 1:2698 N GALLOWAY AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6384
Practice Address - Country:US
Practice Address - Phone:972-288-1662
Practice Address - Fax:972-289-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty