Provider Demographics
NPI:1619959186
Name:QUREIYEH, FARES (MD)
Entity Type:Individual
Prefix:
First Name:FARES
Middle Name:
Last Name:QUREIYEH
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 1:5511 S CONGRESS AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1140
Mailing Address - Country:US
Mailing Address - Phone:561-642-3094
Mailing Address - Fax:561-642-3095
Practice Address - Street 1:5511 S CONGRESS AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1140
Practice Address - Country:US
Practice Address - Phone:561-642-3094
Practice Address - Fax:561-642-3095
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218321207RC0200X, 207RP1001X, 207R00000X
FLME106207207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2010950Medicaid
FL001932500Medicaid
MA2010950Medicaid