Provider Demographics
NPI:1093704785
Name:FAYYAD, ABEER S (MD)
Entity Type:Individual
Prefix:DR
First Name:ABEER
Middle Name:S
Last Name:FAYYAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5095 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2971
Mailing Address - Country:US
Mailing Address - Phone:810-875-9129
Mailing Address - Fax:810-407-6934
Practice Address - Street 1:5095 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2971
Practice Address - Country:US
Practice Address - Phone:810-875-9129
Practice Address - Fax:810-407-6934
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7678277OtherAETNA
MI110B510530OtherBLUE CARE NETWORK
MI1102505941OtherBLUE CROSS BLUE SHIELD
MI1002798OtherMCLAREN HEALTH PLAN
MI110B510530OtherBLUE CROSS BLUE SHIELD
MI4499237Medicaid
MI0993593OtherHEALTH PLUS OF MI
MI1002798OtherHEALTH ADVANTAGE NETWORK
MIC8137OtherMCARE
MICD3610/P00107418OtherMETRAHEALTH
MIH50166OtherHEALTH ALLIANCE PLAN
MIH50166OtherHEALTH NET FEDERAL
MICD3610/P00107418OtherMETRAHEALTH
MI0M28450Medicare ID - Type Unspecified
MI4499237Medicaid