Provider Demographics
NPI:1063702470
Name:ESSAM ATTIA, M.D., P.A.
Entity type:Organization
Organization Name:ESSAM ATTIA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ESSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-747-7330
Mailing Address - Street 1:210 JUPITER LAKES BLVD STE 3201
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7189
Mailing Address - Country:US
Mailing Address - Phone:561-747-7330
Mailing Address - Fax:561-747-3538
Practice Address - Street 1:210 JUPITER LAKES BLVD STE 3201
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7189
Practice Address - Country:US
Practice Address - Phone:561-747-7330
Practice Address - Fax:561-747-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066958000Medicaid
FL066958000Medicaid
FLD21817Medicare UPIN