Provider Demographics
NPI:1639393051
Name:MAKDESI, FADI (MD)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:
Last Name:MAKDESI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FADI
Other - Middle Name:
Other - Last Name:MAKDSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14200 W CELEBRATE LIFE WAY
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3007
Mailing Address - Country:US
Mailing Address - Phone:623-207-3647
Mailing Address - Fax:623-207-3003
Practice Address - Street 1:14200 W CELEBRATE LIFE WAY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3007
Practice Address - Country:US
Practice Address - Phone:623-207-3647
Practice Address - Fax:623-207-3003
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41817207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ447746Medicaid
AZZ154196Medicare PIN