Provider Demographics
NPI:1184637084
Name:ABOU-ISSA, FADI F (MD)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:F
Last Name:ABOU-ISSA
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 1:8120 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3403
Mailing Address - Country:US
Mailing Address - Phone:985-851-6680
Mailing Address - Fax:985-872-1420
Practice Address - Street 1:8120 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3403
Practice Address - Country:US
Practice Address - Phone:985-851-6680
Practice Address - Fax:985-872-1420
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11737R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4A639Medicare ID - Type Unspecified
LAG41118Medicare UPIN