Provider Demographics
NPI:1255340816
Name:EBEID, SADEK (MD)
Entity type:Individual
Prefix:
First Name:SADEK
Middle Name:
Last Name:EBEID
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:PO BOX 25305
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-5305
Mailing Address - Country:US
Mailing Address - Phone:480-777-5544
Mailing Address - Fax:480-777-9898
Practice Address - Street 1:2304 E GENEVA DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4147
Practice Address - Country:US
Practice Address - Phone:480-777-5544
Practice Address - Fax:480-777-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ370924Medicaid
AZZ141736Medicare PIN
AZG41027Medicare UPIN