Provider Demographics
NPI:1215238894
Name:SADEK R. EBEID, MD, PC
Entity type:Organization
Organization Name:SADEK R. EBEID, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SADEK
Authorized Official - Middle Name:R
Authorized Official - Last Name:EBEID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-777-5544
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ370924Medicaid