Provider Demographics
NPI:1619165891
Name:MICHAIL, FOUAD K (MD)
Entity Type:Individual
Prefix:DR
First Name:FOUAD
Middle Name:K
Last Name:MICHAIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 SALEM-WOODSTOWN RD - ROUTE 45
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079
Mailing Address - Country:US
Mailing Address - Phone:856-935-4315
Mailing Address - Fax:856-935-0040
Practice Address - Street 1:330 SALEM WOODSTOWN RD RT 45
Practice Address - Street 2:SUITE 5
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079
Practice Address - Country:US
Practice Address - Phone:856-935-4315
Practice Address - Fax:856-935-0040
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24404207W00000X
NJ25MA02440400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2843901Medicaid
NJD18561Medicare UPIN
NJ104916Medicare PIN