Provider Demographics
NPI:1689605479
Name:FUAD, SONYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SONYA
Middle Name:
Last Name:FUAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 HIGHWAY 100 S
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1529
Mailing Address - Country:US
Mailing Address - Phone:952-746-5774
Mailing Address - Fax:
Practice Address - Street 1:1660 HIGHWAY 100 S
Practice Address - Street 2:SUITE 250
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1529
Practice Address - Country:US
Practice Address - Phone:952-746-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN32G76FUOtherBCBS
MN1011755OtherPREFERRED ONE
MN1053373OtherARAZ
MNHP18640OtherHEALTHPARTNERS
MN01-04566OtherMEDICA CHOICE
MN104843OtherUCARE
MN255062800Medicaid
MN01-04566OtherMEDICA CHOICE
MN104843OtherUCARE