Provider Demographics
NPI:1578631156
Name:AWAD, SOUSOU GAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SOUSOU
Middle Name:GAD
Last Name:AWAD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3515 W UNION HILLS DR STE 111
Mailing Address - Street 2:623-243-7842
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-2430
Mailing Address - Country:US
Mailing Address - Phone:623-328-8630
Mailing Address - Fax:623-243-7842
Practice Address - Street 1:3515 W UNION HILLS DR STE 111
Practice Address - Street 2:623-243-7842
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-2430
Practice Address - Country:US
Practice Address - Phone:623-328-8630
Practice Address - Fax:623-243-7842
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2017-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ34954207Q00000X
NY233802207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ239934Medicaid
S28895Medicare UPIN
AZ239934Medicaid