Provider Demographics
NPI:1558407361
Name:FADI BAIDOUN MD PC
Entity Type:Organization
Organization Name:FADI BAIDOUN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-425-0522
Mailing Address - Street 1:18181 OAKWOOD BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3960
Mailing Address - Country:US
Mailing Address - Phone:313-425-0522
Mailing Address - Fax:313-425-0544
Practice Address - Street 1:18181 OAKWOOD BLVD STE 305
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3960
Practice Address - Country:US
Practice Address - Phone:313-425-0522
Practice Address - Fax:313-425-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N93010Medicare PIN