Provider Demographics
NPI:1508978289
Name:FAHEY, JOSEPH B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:B
Last Name:FAHEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8681 EAGLE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8628
Mailing Address - Country:US
Mailing Address - Phone:651-251-8021
Mailing Address - Fax:651-251-8050
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-735-0501
Practice Address - Fax:651-735-1870
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN28925207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN697275600Medicaid
MN050000856Medicare ID - Type Unspecified
D81192Medicare UPIN