Provider Demographics
NPI:1316591357
Name:BOURI, FADI M B (MD)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:M B
Last Name:BOURI
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 1:225 ABRAHAM FLEXNER WAY STE 850
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1858
Mailing Address - Country:US
Mailing Address - Phone:502-562-0312
Mailing Address - Fax:502-562-0326
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY STE 850
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1858
Practice Address - Country:US
Practice Address - Phone:502-562-0312
Practice Address - Fax:502-562-0326
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFT597207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYFT597OtherSTATE LICENSE