Provider Demographics
NPI:1386630432
Name:HAFEEZ, FAIZAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FAIZAN
Middle Name:
Last Name:HAFEEZ
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 1:3020 N MCCORD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615
Mailing Address - Country:US
Mailing Address - Phone:419-517-1110
Mailing Address - Fax:419-517-1108
Practice Address - Street 1:3020 N. MCCORD #102.
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615
Practice Address - Country:US
Practice Address - Phone:419-517-1110
Practice Address - Fax:419-517-1108
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350757482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2182883Medicaid
OH2182883Medicaid
F65622Medicare UPIN
OHHA4074281Medicare PIN