Provider Demographics
NPI:1023038809
Name:FAHEL, GHASSAN EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:EDWARD
Last Name:FAHEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1717 N BAYSHORE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1180
Mailing Address - Country:US
Mailing Address - Phone:305-374-7011
Mailing Address - Fax:305-675-2630
Practice Address - Street 1:1717 N BAYSHORE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1180
Practice Address - Country:US
Practice Address - Phone:305-374-7011
Practice Address - Fax:305-675-2630
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI06323Medicare UPIN