Provider Demographics
NPI:1205836608
Name:FADHEEL, FARIS (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIS
Middle Name:
Last Name:FADHEEL
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 1:1312 PROFESSIONAL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8019
Mailing Address - Country:US
Mailing Address - Phone:812-476-7523
Mailing Address - Fax:812-476-6686
Practice Address - Street 1:1312 PROFESSIONAL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8019
Practice Address - Country:US
Practice Address - Phone:812-476-7523
Practice Address - Fax:812-476-6686
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361012302084N0400X
MI43010659102084N0400X
IN01052686A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200271080AMedicaid
H20023Medicare UPIN