Provider Demographics
NPI:1205862612
Name:FAYAD, FADY FAYAD (MD)
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:FAYAD
Last Name:FAYAD
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 1:26515 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1908
Mailing Address - Country:US
Mailing Address - Phone:313-205-0909
Mailing Address - Fax:313-562-0751
Practice Address - Street 1:26515 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1908
Practice Address - Country:US
Practice Address - Phone:313-205-0909
Practice Address - Fax:313-562-0751
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF32494Medicare UPIN
MI0P21230Medicare ID - Type Unspecified