Provider Demographics
NPI:1790955094
Name:ATTIA, HOSAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HOSAM
Middle Name:
Last Name:ATTIA
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 1:1506 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2425
Mailing Address - Country:US
Mailing Address - Phone:956-583-0202
Mailing Address - Fax:956-583-0200
Practice Address - Street 1:1506 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2425
Practice Address - Country:US
Practice Address - Phone:956-583-0202
Practice Address - Fax:956-583-0200
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095475207W00000X
NY254811207W00000X
KY49141207W00000X
PAMD438233207W00000X
FLME105560207W00000X, 207WX0107X
TXS6120207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX416214101Medicaid
KY7011411230Medicaid
KYK166120Medicare PIN
FLCT499UMedicare PIN
FLCT499WMedicare PIN
FL001842700OtherMEDICAID
FLCT499VMedicare PIN