Provider Demographics
NPI:1386635480
Name:FAKIH, FAISAL A (MD)
Entity Type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:A
Last Name:FAKIH
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 1:1788 W FAIRBANKS AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789
Mailing Address - Country:US
Mailing Address - Phone:407-740-5447
Mailing Address - Fax:407-740-5532
Practice Address - Street 1:1788 W FAIRBANKS AVE
Practice Address - Street 2:STE A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-740-5447
Practice Address - Fax:407-740-5532
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269557000Medicaid
FL290002724OtherRAILROAD MEDICARE
FL290002724OtherRAILROAD MEDICARE
FL47311YMedicare ID - Type Unspecified