Provider Demographics
NPI:1871925610
Name:FAHAD, FADI (MD)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:FAHAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 E HIGHWAY 90 STE 200
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-9113
Mailing Address - Country:US
Mailing Address - Phone:520-263-3551
Mailing Address - Fax:
Practice Address - Street 1:5750 E HIGHWAY 90 STE 200
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-9113
Practice Address - Country:US
Practice Address - Phone:520-263-3765
Practice Address - Fax:520-263-3567
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62980207RI0011X
CT65693390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology