Provider Demographics
NPI:1447284658
Name:MIDANI, FATMA (MD)
Entity type:Individual
Prefix:
First Name:FATMA
Middle Name:
Last Name:MIDANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 WYOMING BLVD NE STE J
Mailing Address - Street 2:PMB 137
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3873
Mailing Address - Country:US
Mailing Address - Phone:505-507-4770
Mailing Address - Fax:575-443-7636
Practice Address - Street 1:5901 WYOMING BLVD NE STE J
Practice Address - Street 2:PMB 137
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3873
Practice Address - Country:US
Practice Address - Phone:505-507-4770
Practice Address - Fax:575-443-7636
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM20040537207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30532281Medicaid
NM30532281Medicaid