Provider Demographics
NPI:1689634727
Name:HAYEK, FATHALLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:FATHALLAH
Middle Name:
Last Name:HAYEK
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 1:36000 EUCLID AVE # MSO
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4625
Mailing Address - Country:US
Mailing Address - Phone:440-953-6082
Mailing Address - Fax:440-953-6101
Practice Address - Street 1:6270 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2567
Practice Address - Country:US
Practice Address - Phone:440-428-6800
Practice Address - Fax:440-255-3637
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053400207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH264200002OtherFEDERAL BLACK LUNG
OH000000339404OtherANTHEM
OH0623043Medicaid
OH264200002OtherDEPT OF LABOR
OHH059041OtherMEDICARE
OH341425870040OtherMEDICAL MUTUAL OF OHIO
OH6600162OtherUNITED HEALTHCARE
OH80507OtherQUALCHOICE
OH264200002OtherFEDERAL BLACK LUNG
OH341425870040OtherMEDICAL MUTUAL OF OHIO