Provider Demographics
NPI:1710032131
Name:SAAD, SHAKER FAWZY YOUSSEF (MD)
Entity Type:Individual
Prefix:
First Name:SHAKER
Middle Name:FAWZY YOUSSEF
Last Name:SAAD
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 1:1618 GOLDRUSH RD
Mailing Address - Street 2:SUITE 227
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8380
Mailing Address - Country:US
Mailing Address - Phone:928-704-1422
Mailing Address - Fax:928-704-1457
Practice Address - Street 1:1618 GOLDRUSH RD APT 227
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8388
Practice Address - Country:US
Practice Address - Phone:928-234-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036164869207R00000X, 208M00000X
AZ28999208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0734220OtherBCBS PROVIDER ID
AZ569022Medicaid
AZ569022Medicaid
AZAZ0734220OtherBCBS PROVIDER ID
AZH41461Medicare UPIN
AZ331050297OtherFEDERAL TAX ID NUMBER