Provider Demographics
NPI:1760493001
Name:WADI, MUSA A (MD)
Entity Type:Individual
Prefix:
First Name:MUSA
Middle Name:A
Last Name:WADI
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 1:1208 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5602
Mailing Address - Country:US
Mailing Address - Phone:940-322-4480
Mailing Address - Fax:940-322-8420
Practice Address - Street 1:1208 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5602
Practice Address - Country:US
Practice Address - Phone:940-322-4480
Practice Address - Fax:940-322-8420
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999139399207RP1001X
TXP5312207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322868601Medicaid
TX322868602Medicaid
TX322868603Medicaid
TXP01264355OtherMEDICARE RAILROAD
MO1999139399OtherMISSOURI LICENSE
TX307702YNAQMedicare PIN
MOF96032Medicare UPIN
TX322868601Medicaid
TXP01264355OtherMEDICARE RAILROAD
TX307702YXZ4Medicare PIN