Provider Demographics
NPI:1396920922
Name:GHADIR ISSA MD PA
Entity type:Organization
Organization Name:GHADIR ISSA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHADIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-217-4011
Mailing Address - Street 1:947 SCOTLAND DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2093
Mailing Address - Country:US
Mailing Address - Phone:214-217-4011
Mailing Address - Fax:214-217-4016
Practice Address - Street 1:947 SCOTLAND DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2093
Practice Address - Country:US
Practice Address - Phone:214-217-4011
Practice Address - Fax:214-217-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5165208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty