Provider Demographics
NPI:1508025867
Name:FAYAD, ZIAD YOUSSEF (MD)
Entity Type:Individual
Prefix:
First Name:ZIAD
Middle Name:YOUSSEF
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 1:611 E DOUGLAS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1465
Mailing Address - Country:US
Mailing Address - Phone:574-272-5347
Mailing Address - Fax:574-272-8617
Practice Address - Street 1:611 E DOUGLAS RD STE 200
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1465
Practice Address - Country:US
Practice Address - Phone:574-272-5347
Practice Address - Fax:574-272-8617
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075159A208600000X, 2086S0129X, 2086S0129X
WI604402086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201292160Medicaid
IN264180021Medicare PIN