Provider Demographics
NPI:1285640169
Name:FADEL, AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:FADEL
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 1:1001 SE OCEAN BLVD
Mailing Address - Street 2:SUITE 103C
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-2511
Mailing Address - Country:US
Mailing Address - Phone:772-287-9143
Mailing Address - Fax:772-287-9144
Practice Address - Street 1:1001 SE OCEAN BLVD
Practice Address - Street 2:SUITE 103C
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-2511
Practice Address - Country:US
Practice Address - Phone:772-287-9143
Practice Address - Fax:772-287-9144
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1386ZMedicare ID - Type Unspecified
FLU1386UMedicare PIN
FLG71250Medicare UPIN