| Gadstar Family Medicine | |
|
3515 W Union Hills Dr Ste 111 Glendale AZ 85308-2430 | |
| (623) 328-8630 | |
| (623) 243-7842 |
| Full Name | Gadstar Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 3515 W Union Hills Dr Ste 111, Glendale, Arizona |
| Authorized Official Name and Position | Sousou Gad Awad (MEMBER/MANAGING EMPLOYEE) |
| Authorized Official Contact | 4803897019 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gadstar Family Medicine 3515 W Union Hills Dr Ste 111 Glendale AZ 85308-2430 Ph: (623) 328-8630 | Gadstar Family Medicine 3515 W Union Hills Dr Ste 111 Glendale AZ 85308-2430 Ph: (623) 328-8630 |
| NPI Number | 1649719071 |
|---|---|
| Provider Enumeration Date | 02/17/2017 |
| Last Update Date | 02/17/2017 |
| Medicare PECOS PAC ID | 2365727609 |
|---|---|
| Medicare Enrollment ID | O20170328002158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649719071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Arizona) | Primary |
| Provider Name | Sousou G Awad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578631156 PECOS PAC ID: 6305939497 Enrollment ID: I20070906000039 |
| Provider Name | Idris A Idris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710545355 PECOS PAC ID: 6608107909 Enrollment ID: I20191017002984 |
| Provider Name | Shayna Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770101172 PECOS PAC ID: 3577970219 Enrollment ID: I20210325001389 |
| Provider Name | Jyldyz Temirkan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497463715 PECOS PAC ID: 4082088844 Enrollment ID: I20230316002383 |
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