Provider Demographics
NPI:1144224163
Name:FADEM, STEPHEN ZALE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ZALE
Last Name:FADEM
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:PO BOX 300970
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-0970
Mailing Address - Country:US
Mailing Address - Phone:713-795-5511
Mailing Address - Fax:713-795-4627
Practice Address - Street 1:6560 FANNIN ST STE 1730
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2735
Practice Address - Country:US
Practice Address - Phone:713-795-5511
Practice Address - Fax:713-795-4627
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3262207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127862401Medicaid
TX127862401Medicaid
TX81090XOtherBC/BS
TXB22602Medicare UPIN
TX127862401Medicaid