Provider Demographics
NPI:1821066184
Name:ABU-GHAZALEH, SAMIR ZAKI (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:ZAKI
Last Name:ABU-GHAZALEH
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 1:1000 E 21ST ST
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1035
Mailing Address - Country:US
Mailing Address - Phone:605-331-3898
Mailing Address - Fax:
Practice Address - Street 1:1000 E 21ST ST
Practice Address - Street 2:SUITE 3000
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1035
Practice Address - Country:US
Practice Address - Phone:605-331-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD2615207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6200292Medicaid
SDP00741293OtherRR MEDICARE
SDS103183Medicare PIN