Provider Demographics
NPI:1144242892
Name:KANNOUT, FAREED (MD)
Entity Type:Individual
Prefix:DR
First Name:FAREED
Middle Name:
Last Name:KANNOUT
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 3528
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72913-3528
Mailing Address - Country:US
Mailing Address - Phone:479-274-2000
Mailing Address - Fax:479-274-2194
Practice Address - Street 1:4600 TOWSON AVE STE 101-N
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7961
Practice Address - Country:US
Practice Address - Phone:479-274-6900
Practice Address - Fax:479-648-3951
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127260001Medicaid
110181109OtherRR MEDICARE
110181109OtherRR MEDICARE
AR5J691Medicare ID - Type Unspecified