Individual
WISAM FAWZI SHABA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
14775 W YORKSHIRE DR, SURPRISE, AZ 85374-7224
(623) 594-5050
Mailing address
PO BOX 11773, CHANDLER, AZ 85248-0013
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
50677
AZ
207U00000X
Nuclear Medicine Physician
A117646
CA
2085R0202X
Diagnostic Radiology Physician
A117646
CA
Other
Enumeration date
01/10/2012
Last updated
03/30/2022
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